Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients

OBJECTIVE Intensive care unit delirium is an increasingly recognized problem in pediatric patients. Controversy exists regarding the safety and efficacy of antipsychotic medications for this indication. The objective of this study was to determine the incidence of and risk factors for QTc interval prolongation in pediatric patients treated with antipsychotics for ICU delirium. METHODS Retrospective chart review of pediatric patients admitted to the pediatric ICU or pediatric cardiac ICU and diagnosed with ICU delirium between October 1, 2014, and October 31, 2015. Patients were included if they received at least 1 dose of an antipsychotic for the treatment of delirium after a positive screen using the Cornell Assessment of Pediatric Delirium scoring tool. RESULTS For the 26 patients included, the median change in QTc interval on treatment was −4 msecs. Two patients (8%) had QTc interval prolongation while on antipsychotic therapy. No risk factors were identified in these 2 patients that put them at increased risk for QTc interval prolongation. CONCLUSIONS The incidence of QTc interval prolongation in pediatric patients who were treated with antipsychotics for ICU delirium was low. There is need for future research to determine which pediatric patients are at risk for QTc interval prolongation when antipsychotic medications are used for the treatment of ICU delirium.

Download Full-text

Severe quetiapine voluntary overdose successfully treated with a new hemoperfusion sorbent

The International Journal of Artificial Organs ◽

10.1177/0391398819837686 ◽

2019 ◽

Vol 42 (9) ◽

pp. 516-520 ◽

Cited By ~ 1

Author(s):

Lorenzo Giuntoli ◽

Vittorio Dalmastri ◽

Nicola Cilloni ◽

Claudio Orsi ◽

Lucia Stalteri ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Potential Application ◽

Healthy Woman ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

Quetiapine overdose, although rare, is mainly linked with tachycardia, QTc-interval prolongation, somnolence, coma, hyperglycemia, and eventually hepatotoxicity and myocarditis. Extracorporeal techniques for quetiapine removal might be helpful, but only a few cases are reported in the literature. We here describe the case of a 27-year-old healthy woman, admitted to our Intensive Care Unit after voluntary quetiapine intake and successfully treated with CytoSorb hemoperfusion in combination with continuous renal replacement therapy (CRRT), in order to accelerate quetiapine elimination. This is the first published experience about the potential application of hemoadsorption therapies, as CytoSorb sorbent, in large overdoses of quetiapine and this approach might be feasible to rapidly remove the substance from blood, stabilizing the patient condition.

Download Full-text

Vancomycin-induced nephrotoxicity in non-intensive care unit pediatric patients

Scientific Reports ◽

10.1038/s41598-021-00214-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinhyeung Kwak ◽

Jeong Yeon Kim ◽

Heeyeon Cho

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Patients ◽

Trough Level ◽

Medical Center ◽

Kidney Injury ◽

Maximum Serum ◽

Serum Trough ◽

Youden’S Index

AbstractPrevious data suggested several risk factors for vancomycin-induced nephrotoxicity (VIN), including higher daily dose, long-term use, underlying renal disease, intensive care unit (ICU) admission, and concomitant use of nephrotoxic medications. We conducted this study to investigate the prevalence and risk factors of VIN and to estimate the cut-off serum trough level for predicting acute kidney injury (AKI) in non-ICU pediatric patients. This was a retrospective, observational, single-center study at Samsung Medical Center tertiary hospital, located in Seoul, South Korea. We reviewed the medical records of non-ICU pediatric patients, under 19 years of age with no evidence of previous renal insufficiency, who received vancomycin for more than 48 h between January 2009 and December 2018. The clinical characteristics were compared between patients with AKI and those without to identify the risk factors associated with VIN, and the cut-off value of serum trough level to predict the occurrence of VIN was calculated by the Youden’s index. Among 476 cases, 22 patients (4.62%) developed AKI. The Youden’s index indicated that a maximum serum trough level of vancomycin above 24.35 μg/mL predicted VIN. In multivariate analysis, longer hospital stay, concomitant use of piperacillin-tazobactam and serum trough level of vancomycin above 24.35 μg/mL were associated independently with VIN. Our findings suggest that concomitant use of nephrotoxic medication and higher serum trough level of vancomycin might be associated with the risk of VIN. This study suggests that measuring serum trough level of vancomycin can help clinicians prevent VIN in pediatric patients.

Download Full-text

A Unique Case Presentation of Methadone Toxicity without QTc Interval Prolongation despite Patient Risk Factors

Clinical Studies & Medical Case Reports ◽

10.24966/csmc-8801/100057 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1-6

Author(s):

Keith T Veltri ◽

Keyword(s):

Risk Factors ◽

Qtc Interval ◽

Interval Prolongation ◽

Unique Case ◽

Patient Risk ◽

Case Presentation ◽

Qtc Interval Prolongation

Download Full-text

Meperidine-induced QTc-interval prolongation: prevalence, risk factors, and correlation to plasma drug and metabolite concentrations

International Journal of Clinical Pharmacology and Therapeutics ◽

10.5414/cp202612 ◽

2017 ◽

Vol 55 (03) ◽

pp. 275-285 ◽

Cited By ~ 8

Author(s):

Guillermo Alberto Keller ◽

María Cedilia Villa Etchegoyen ◽

Nicolás Fernández ◽

Nancy Mónica Olivera ◽

Patricia Noemi Quiroga ◽

...

Keyword(s):

Risk Factors ◽

Qtc Interval ◽

Plasma Drug ◽

Interval Prolongation ◽

Qtc Interval Prolongation ◽

Metabolite Concentrations

Download Full-text

Changes In QTc Interval Duration Among Heroin Addicts On Methadone Treatment

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2015-0029 ◽

2015 ◽

Vol 16 (3) ◽

pp. 217-228

Author(s):

Mirjana Jovanovic ◽

Mladen Divnic ◽

Milan Jovanovic ◽

Sasa Babic ◽

Katarina Nikic Djuricic ◽

...

Keyword(s):

Risk Factors ◽

Illicit Drugs ◽

Methadone Treatment ◽

Torsade De Pointes ◽

Diagnostic Methods ◽

Qtc Interval ◽

Interval Prolongation ◽

Safety Level ◽

Co Morbidity ◽

Qtc Interval Prolongation

AbstractThis paper aimed to collect and unite facts known about the effect of methadone treatment on QTc interval prolongation that could determine precipitating factors in the development of heart arrhythmias and their consequences (Torsade de Pointes and sudden cardiac death), and to raise the methadone treatment safety level.Studies conducted up to now clearly demonstrate that methadone therapy evokes changes in the heart’s electrical conduction, but those studies also show that QTc interval prolongation could be precipitated by other factors. The most often present risk factors in our research were dose of methadone, co-medication, and co-morbidity, but other relevant risk factors were gender, age, misuse of illicit drugs, therapy length and tobacco use.Active participation in modern treatment processes and implementation of knowledge acquired recently into daily practice, such as setting up reutilized questionnaires and diagnostic methods to expose higher risk for complications and providing broader therapeutic range for cases of drug replacement necessity, will enhance therapy safety level and bring us to the next step of resocialization of these patients, which needs to remain the final goal of treatment.

Download Full-text

Drug-Induced QTc-Interval Prolongation in the Intensive Care Unit: Incidence and Predictors

Journal of Pharmacy Practice ◽

10.1177/0897190009356549 ◽

2010 ◽

Vol 23 (1) ◽

pp. 19-24 ◽

Cited By ~ 16

Author(s):

Tien M. H. Ng ◽

Keith M. Olsen ◽

Megan A. McCartan ◽

Susan E. Puumala ◽

Katie M. Speidel ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Beta Blockers ◽

Qtc Interval ◽

Qtc Prolongation ◽

Drug Induced ◽

Icu Patients ◽

End Point ◽

Increased Risk ◽

Qtc Interval Prolongation

There is a paucity of information regarding QTc prolongation in critically ill patients. A prospective observational study was conducted to assess the incidence and predictors of QTc prolongation associated with medications in intensive care unit (ICU) patients. Consecutive adult patients prescribed prespecified QTc-prolonging medications were assessed for development of the combined incidence of QTc >500 ms at anytime and QTc increase >60 ms above baseline. Over 3 months, 200 consecutive patients (63 ± 18 years; 52% female; 73% Caucasian; baseline QTc 447.3 ± 51.5 ms) were evaluated. The primary end point occurred in 48% of the patients (QTc >500 ms 40%, QTc increase >60 ms 29%). The majority of patients experienced a QTc >470 or 450 ms (60.5%). Mean increase in QTc at 48 hours was 20 ± 35 ms. Upon multivariate analysis, length of stay [odds ratio 1.30, 95% confidence interval (1.15, 1.47)] and baseline QTc [1.01 (1.01, 1.02)] were associated with an increased risk for the primary end point, while beta-blockers [0.41 (0.20, 0.81)] were associated with a risk reduction. In conclusion, increased risk of proarrhythmia, as assessed by QTc prolongation, occurs in the majority of ICU patients when prescribed medications with electrophysiologic properties. Increased vigilance is warranted. The possible protective effect of beta-blockers requires confirmation.

Download Full-text