The Role of Quetiapine in Treating Delirium in Critical Care Settings: A Narrative Review

Abstract

Delirium is a frequent complication in critically ill patients, often leading to worse clinical outcomes, prolonged ICU stays, and an increased healthcare burden. Its identification has become more consistent with the adoption of validated diagnostic tools, allowing clinicians to recognize and address this condition more effectively. Although delirium can arise from direct neurological dysfunction, it is frequently a consequence of systemic conditions such as sepsis or organ failure. Therefore, a comprehensive evaluation of underlying causes is essential before initiating pharmacological treatment. Among the pharmacological options, quetiapine has gained attention for its use in ICU patients with delirium. Compared to first-generation antipsychotics, it is often preferred due to its sedative effects and more favorable safety. However, current clinical guidelines remain inconclusive regarding its routine use, as evidence supporting its efficacy is limited. One of the main challenges is the heterogeneity of patient populations included in randomized trials, making it difficult to determine whether specific subgroups may benefit more from treatment. This narrative review explores the pharmacological properties of quetiapine, its potential role in managing ICU delirium, and the current state of evidence regarding its safety and effectiveness.

Keywords: ICU; antipsychotics in ICU; delirium; quetiapine.

Figure 1

Practical approach to managing delirium in the ICU.