Benzodiazepines for delirium

 

Abstract

Background

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.

Objectives

To determine the effectiveness and incidence of adverse effects of benzodiazapines in the treatment of non-alcohol withdrawal related delirium.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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.

 

摘要

背景

Benzodiazepines用於治療譫妄

住院病患中，有30%發生譫妄及因此延長留院時間，並且增加罹病率及死亡率。沒有對照組的研究結果不明確，有些結果認為benzodiazepines可能對於控制非酒精性的譫妄有幫助

目標

確認以benzodiazapines治療非酒精戒斷譫妄的效果以及不良效果的發生率

搜尋策略

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

選擇標準

試驗必須為未受干擾、隨機且對於受試者進行遮盲。此外，所挑選的試驗必需在治療前後評估受試者。若出現的為交叉試驗設計，則僅分析來自試驗第一部分的數據

資料收集與分析

2位回顧作者自納入的試驗摘取資料。合適時將會合併數據，且使用適當的統計方法分析。計算Odd ratios或平均差。僅治療意向資料被納入

主要結論

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−2adrenergic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

作者結論

沒有發現適當的對照試驗支持在治療住院病患非酒精性戒斷譫妄時使用benzodiazepines來治療，且目前不能建議使用benzodiazepines進行控制。因為缺乏使用病患隨機進行的試驗、缺乏安慰劑對照、以及缺乏適當受試者遮盲。明顯需要進一步的研究以確認benzodiazepines在治療非酒精性戒斷譫妄時的功效

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

目前不建議使用benzodiazepines治療非酒精性戒斷譫妄:對於benzodiazepine治療非酒精性戒斷譫妄的系統性文獻回顧發現試驗很少(一隨機性的、人工換氣病患的對照研究，以及因此不足以整體反映出譫妄病患；以及兩份部分對照研究)，這些結果指出現在並無證據支持在住院病患中使用benzodiazepines來治療非酒精性戒斷譫妄