Cited by 223Intensive Care Unit Cognitive DisordersAlcoholism and Thiamine DeficiencyAnesthesia and Sedative Agents

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Benzodiazepines for delirium

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Lonergan, Edmund, Luxenberg, Jay, Areosa Sastre, Almudena·2009·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd006379.pub3PMC PMC6669269

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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 STRATEGY: 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.

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Authors: Lonergan, E., Luxenberg, J., & Areosa Sastre, A.
Affiliations: 4 Captain Drive Apt 215 Emeryville CA USA 94608
Jewish Home (US)
c/ Mauricio Legendre 17, 5-A Madrid Spain 28046
ORCID: Luxenberg, Jay
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2009-10-07
Volume: 2010
Issue: 1
Pages: CD006379-CD006379
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd006379.pub3
PMC: PMC6669269
OpenAlex: W1903577601
Cited by: 223
References: 30
Citations by year: 2026: 5 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 41 · 2019: 14 · 2018: 12 · 2017: 12 · 2016: 11 · 2015: 17 · 2014: 16 · 2013: 19 · 2012: 22
FWCI: 2.42
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Health Sciences › Medicine › Clinical Neurology › Alcoholism and Thiamine Deficiency
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Keywords: delirium, benzodiazepines, lorazepam, dexmedetomidine, alprazolam, antipsychotic drugs, haloperidol, chlorpromazine, agitation, mechanical ventilation, intensive care unit patients, adverse effects, treatment effectiveness, hospitalized patients, benzodiazepine withdrawal
MeSH terms: Benzodiazepines, Delirium, Humans, Lorazepam, Dexmedetomidine

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