- Design
- Retrospective claims cohort
- Population
- 7,898 US adults discharged after ICU with mechanical ventilation
- Primary outcome
- New psychoactive prescriptions without a supporting diagnosis
- Effect
- 5.3% newly prescribed; 42.8% of prescriptions without documented diagnosis
A Critical Care Medicine claims study followed 7,898 US adults discharged after an ICU stay with mechanical ventilation who had not been on psychoactive drugs before.
5.3% were newly prescribed one within 30 days of discharge: anxiolytics, antidepressants, antipsychotics or sleep aids. 42.8% of those prescriptions had no documented supporting diagnosis, including 52.4% of antipsychotics. The pattern persisted for up to two years.
Antipsychotics and sedatives started for delirium or agitation in ICU are often continued at discharge without a plan to stop. These data suggest the problem is common and long-lasting.
Claims data cannot show whether prescriptions were inappropriate, only that the reason was not recorded. But a missing indication is exactly what makes a drug hard to stop later.
- Review every antipsychotic or sedative at ICU and hospital discharge and stop those started only for delirium
- Record the indication and a stop date for any psychoactive drug continued at discharge
- Tell the primary care doctor which drugs were started in hospital and why
- Screen ICU survivors for anxiety, depression and post-traumatic stress, which are common and treatable
Why it matters
Drugs started for delirium in intensive care can follow survivors home for years.
Don't overread it
A missing diagnosis code is not proof that a prescription was inappropriate.
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