Quetiapine therapy in critically injured trauma patients is associated with an increased risk of pulmonary complications

Lyndsey E Wessels; James D Wallace; Richard Y Calvo; Tatyana Levko; Jason M Bowie; William J Butler; Vishal Bansal; C Beth Sise; Matthew J Martin; Michael J Sise

doi:10.1016/j.amjsurg.2020.02.033

Quetiapine therapy in critically injured trauma patients is associated with an increased risk of pulmonary complications

Am J Surg. 2020 May;219(5):804-809. doi: 10.1016/j.amjsurg.2020.02.033. Epub 2020 Feb 20.

Authors

Affiliations

¹ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: lyndseywessels@gmail.com.
² Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: jw05umass@gmail.com.
³ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: calvo.richard@scrippshealth.org.
⁴ Pharmacy Department, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: levko.tatyana@scrippshealth.org.
⁵ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: jbowie7@gmail.com.
⁶ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: jasonbutler.navy@gmail.com.
⁷ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: bansal.vishal@scrippshealth.org.
⁸ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: sise.beth@scrippshealth.org.
⁹ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: martin.matthew@scrippshealth.org.
¹⁰ Trauma Service, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. Electronic address: sise.mike@scrippshealth.org.

PMID: 32102757
DOI: 10.1016/j.amjsurg.2020.02.033

Abstract

Background: The aim of this study was to evaluate quetiapine-associated pulmonary complications (PC) in critically injured trauma patients.

Methods: Injured adults admitted during 2016 to the ICU at a Level I trauma center were analyzed. Outcomes were evaluated by competing risks survival analysis.

Results: Of 254 admissions, 40 (15.7%) had PC and 214 (84.3%) were non-events. PC patients were more severely injured, had longer hospital stays and were more likely to die. Patients administered quetiapine were more likely to develop PC and acquire PC earlier than those without quetiapine. Quetiapine was a positive risk factor for PC (sHR 2.24, p = 0.013). Stratification by ventilator use revealed non-ventilated patients administered quetiapine had the highest risk for PC (sHR 4.66, p = 0.099).

Conclusions: Quetiapine exposure in critically injured trauma patients was associated with increased risk of PC. Guidelines for treatment of delirium with quetiapine in critically injured trauma patients should account for this risk.

Keywords: Delirium; Pulmonary complications; Quetiapine; Sedation; Trauma.

MeSH terms

Antipsychotic Agents / adverse effects*
Critical Illness*
Delirium / drug therapy*
Delirium / etiology*
Female
Humans
Intensive Care Units
Lung Diseases / chemically induced*
Male
Middle Aged
Quetiapine Fumarate / adverse effects*
Retrospective Studies
Risk Factors
Trauma Centers
Wounds and Injuries / complications*

Substances

Antipsychotic Agents
Quetiapine Fumarate