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Benzodiazepines for delirium
Open accessAbstract
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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“However, no evidence for medication efficacy, including cholinesterase inhibitors, antipsychotic medication, or melatonin exists.287, 288, 289”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [289]
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Metadata
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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