• Mary K La, Melissa L Thompson Bastin, Jenee T Gisewhite, Carrie A Johnson, and Alexander H Flannery.
• University of North Carolina Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, Chapel Hill, NC, United States. Electronic address: mary_la@unc.edu.
• J Crit Care. 2018 Feb 1; 43: 102-107.

PurposeThis single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.Materials And MethodsSubjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay.ResultsThere were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of -1.5, while late cohort patients had a median daily RASS of -2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).ConclusionsRestarting home NPMs was associated with lighter sedation levels and less delirium.Copyright © 2017 Elsevier Inc. All rights reserved.

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