2023
Trends in use of antipsychotics and psychoactive drugs in older patients after major surgery
Kim D, Lee H, Pawar A, Lee S, Park C, Levin R, Metzger E, Bateman B, Ely E, Pandharipande P, Pisani M, Hohmann S, Marcantonio E, Inouye S. Trends in use of antipsychotics and psychoactive drugs in older patients after major surgery. Journal Of The American Geriatrics Society 2023, 71: 3755-3767. PMID: 37676699, PMCID: PMC10841351, DOI: 10.1111/jgs.18580.Peer-Reviewed Original ResearchConceptsUse of antipsychoticsAcademic medical centerCommunity hospitalPostoperative periodHospital typeSurgical admissionsOlder patientsMajor surgeryAtypical antipsychoticsPsychoactive drugsIntensive care unit settingRetrospective cohort studyUse of haloperidolNon-ICU settingsUse of antiepilepticsProfessional society guidelinesPostoperative deliriumPatients 65Cohort studyHospital daysHypnotic useAgonist dexmedetomidineSociety guidelinesUnit settingMedical CenterComparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery : A Nationwide Cohort Study.
Kim D, Lee S, Park C, Levin R, Metzger E, Bateman B, Ely E, Pandharipande P, Pisani M, Jones R, Marcantonio E, Inouye S. Comparative Safety Analysis of Oral Antipsychotics for In-Hospital Adverse Clinical Events in Older Adults After Major Surgery : A Nationwide Cohort Study. Annals Of Internal Medicine 2023, 176: 1153-1162. PMID: 37665998, PMCID: PMC10625498, DOI: 10.7326/m22-3021.Peer-Reviewed Original ResearchConceptsTransient ischemic attackAdverse clinical eventsHospital deathMajor surgeryClinical eventsPostoperative deliriumCohort studyOlder patientsAntipsychotic drugsArrhythmia eventsCardiac arrhythmia eventsHospital adverse clinical eventsModerate-dose treatmentPremier Healthcare DatabaseHospital adverse eventsNationwide cohort studyRetrospective cohort studyAtypical antipsychotic useOral antipsychotic drugsSignificant differencesHaloperidol useIschemic attackOral antipsychoticsAdverse eventsOral haloperidol
2016
Continuation Rate of Atypical Antipsychotics After Discharge When Initiated in the Intensive Care Unit
Farrokh S, Castle AC, Heavner M, Pisani MA. Continuation Rate of Atypical Antipsychotics After Discharge When Initiated in the Intensive Care Unit. Journal Of Pharmacy Practice 2016, 30: 342-346. PMID: 27129913, DOI: 10.1177/0897190016645026.Peer-Reviewed Original ResearchConceptsIntensive care unitAtypical antipsychoticsHospital dischargeCare unitSafety outcomesLarge tertiary academic medical centerTertiary academic medical centerFinal study populationAcademic medical centerICU stayLack of evidenceCritical illnessMedical chartsQTc prolongationExtended therapyContinuation ratesInappropriate continuationMedical CenterStudy populationAntipsychoticsExclusion criteriaPhysician documentationPatientsProgress notesOutcomes
2015
Awake or Sedated: Trends in the Evaluation and Management of Agitation in the Intensive Care Unit
DeBiasi EM, Akgün KM, Pisani M. Awake or Sedated: Trends in the Evaluation and Management of Agitation in the Intensive Care Unit. Seminars In Respiratory And Critical Care Medicine 2015, 36: 899-913. PMID: 26595050, DOI: 10.1055/s-0035-1564875.BooksConceptsICU patientsSedation practicesIll intensive care unit (ICU) patientsIntensive care unit patientsSedation assessment scaleMechanical ventilation durationCare unit patientsManagement of agitationMost ICU patientsIntensive care unitImproved clinical outcomesMultidisciplinary treatment modelLife-saving interventionsHospital lengthMinimal sedationSedative medicationsUnit patientsCare unitClinical outcomesMechanical ventilationVentilation durationPatient distressFunctional impairmentPractice guidelinesPatient discomfort
2013
Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit
Pisani MA, Bramley K, Vest MT, Akgün KM, Araujo KL, Murphy TE. Patterns of Opiate, Benzodiazepine, and Antipsychotic Drug Dosing in Older Patients in a Medical Intensive Care Unit. American Journal Of Critical Care 2013, 22: e62-e69. PMID: 23996429, PMCID: PMC4309662, DOI: 10.4037/ajcc2013835.Peer-Reviewed Original ResearchConceptsMedical intensive care unitIntensive care unitOlder patientsCare unitNursing shiftsHigh dosesEvening shiftsNight shiftsYale-New Haven HospitalEvening nursing shiftsPatients 60 yearsRoute of administrationImportant clinical covariatesMean ageClinical covariatesPsychoactive medicationsDrug dosingRandom effects Poisson modelDose levelsPatientsHaloperidolTotal dosesLorazepamSleep deprivationFentanyl
2012
ICU delirium
Jones SF, Pisani MA. ICU delirium. Current Opinion In Critical Care 2012, 18: 146-151. PMID: 22322260, DOI: 10.1097/mcc.0b013e32835132b9.Peer-Reviewed Original ResearchMeSH KeywordsAnesthesia, GeneralAntipsychotic AgentsCritical CareCritical IllnessDeliriumFemaleHaloperidolHumansIntensive Care UnitsMaleRisk FactorsTreatment OutcomeConceptsICU deliriumRisk factorsLong-term neurocognitive impairmentDelirium-related outcomesPreferred pharmacologic treatmentSignificant adverse outcomesUse of sedativesUse of protocolsPharmacologic treatmentAtypical antipsychoticsVentilator managementAdverse outcomesUnderdiagnosed problemDeliriumNeurocognitive impairmentSusceptible individualsAvailable evidenceRecent evidenceOutcomesLong-term impactTreatmentLimited studiesRobust evidenceNegative outcomesManagement