Benzodiazepines for delirium
Editorial Group: Cochrane Dementia and Cognitive Improvement Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 3 JUN 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lonergan E, Luxenberg J, Areosa Sastre A. Benzodiazepines for delirium. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006379. DOI: 10.1002/14651858.CD006379.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 7 OCT 2009
Delirium occurs in 30% of hospitalised patients and is associated with prolonged hospital stay and increased morbidity and mortality. The results of uncontrolled studies have been unclear, with some suggesting that benzodiazepines may be useful in controlling non-alcohol related delirium.
To determine the effectiveness and incidence of adverse effects of benzodiazapines in the treatment of non-alcohol withdrawal related delirium.
The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 26 February 2008 using the search terms: (deliri* or confusion) and (benzo* or lorazepam," or "alprazolam" or "ativan" or diazepam or valium or chlordiazepam).
The CDCIG Specialized Register contains records from major health databases (including MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, LILACS) as well as many ongoing trial databases and grey literature sources.
Trials had to be unconfounded, randomized and with concealed allocation of subjects. Additionally, selected trials had to have assessed patients pre- and post-treatment. Where crossover design was present, only data from the first part of the trial were to be examined.
Data collection and analysis
Two reviewers extracted data from included trials. Data were pooled where possible, and were to be analysed using appropriate statistical methods. Odd ratios or average differences were to be calculated. Only "intention to treat" data were to be included.
Only one trial satisfying the selection criteria could be identified. In this trial, comparing the effect of the benzodiazepine, lorazepam, with dexmedetomidine, a selective alpha-2-adrenergic receptor agonist, on delirium among mechanically ventilated intensive care unit patients, dexmedetomidine treatment was associated with an increased number of delirium- and coma-free days compared with lorazepam treated patients (dexmedetomidine patients, average seven days; lorazepam patients, average three days; P = 0.01). One partially controlled study showed no advantage of a benzodiazepine (alprazolam) compared with neuroleptics in treating agitation associated with delirium, and another partially controlled study showed decreased effectiveness of a benzodiazepine (lorazepam), and increased adverse effects, compared with neuroleptics (haloperidol, chlorpromazine) for the treatment of acute confusion.
No adequately controlled trials could be found to support the use of benzodiazepines in the treatment of non-alcohol withdrawal related delirium among hospitalised patients, and at this time benzodiazepines cannot be recommended for the control of this condition. Because of the scarcity of trials with randomization of patients, placebo control, and adequate concealment of allocation of subjects, it is clear that further research is required to determine the role of benzodiazepines in the treatment of non-alcohol withdrawal related delirium.
Plain language summary
At this time, benzodiazepines cannot be recommended for the treatment of non-alcohol related delirium
A systematic review of benzodiazepine treatment of non-alcohol related delirium discovered very few trials (one randomized, controlled study of mechanically ventilated patients, and thus poorly reflective of delirious patients as a whole; and two partially controlled studies), the results of which indicate that at this time there is no evidence to support the use of benzodiazepines in the treatment of non-alcohol withdrawal related delirium among hospitalised patients.
2008年2月26日搜尋Cochrane Dementia and Cognitive Improvement Group Specialized Register以找出癡呆症或認知損傷者臨床試驗的參考文獻。所使用的關鍵子為: (deliri* or confusion)以及 (benzo* or lorazepam,” or “alprazolam” or “ativan” or diazepam or valium or chlordiazepam)。CDCIG Specialized Registerc不但含有由主要健康資料庫(包含MEDLINE、EMBASE、CINAHL、PsycINFO、CENTRAL、LILACS)的記錄，也包含許多進行中的臨床試驗資料庫及灰色文獻來源
僅找到一項滿足選擇標準的試驗。在這試驗中，比較benzodiazepine、 lorazepam、與dexmedetomidine的功效。dexmedetomidineg是一種選擇性的 alpha−2adrenergic接受抑制劑，施用在加護病房以人工換氣的病患中發生的譫妄。dexmedetomidine治療和lorazepam治療的病患相比較，則與無譫妄及無昏迷日數的增加有關(dexmedetomidine病患:平均7天; lorazepam病患:平均3天; P = 0.01)。 一個部分對照的研究顯示，在治療與瞻望有關的躁動時與神經鬆弛劑相比較，benzodiazepine (alprazolam)並無優異之處。 而另外一個部分對照的研究顯示，benzodiazepine (lorazepam)與neuroleptics (haloperidol, chlorpromazine)相比，在治療急性意識混亂方面，效果較低且不良事件的發生率增加
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌