Effect of Home Antipsychotic Resumption on Sedation in Mechanically Ventilated Adults

Introduction: Abrupt discontinuation or interruption of antipsychotic medications can potentiate withdrawal symptoms such as agitation, anxiety, and insomnia. This can pose a challenge in patients who require light sedation for mechanical ventilation. Subsequently, these patients may have poor sedation control, potentially contributing to delayed extubation and longer ICU length of stay. This study aims to analyze the impact of abrupt interruptions of antipsychotic medication on sedation in mechanically ventilated patients.


Methods: This study was a single-center retrospective chart review of adult patients admitted to Community Medical Center who required ≥ 48 hours of mechanical ventilation between January 1, 2023 and May 31, 2025 who were on antipsychotic medication(s) prior to admission. Patients who had home antipsychotics that were resumed within 24 hours were compared to those who were resumed greater than 24 hours. Patients who were admitted for acute medication overdose, had mechanical ventilation < 48 hours, or were on a long-acting injectable antipsychotic medication were excluded from the study. The primary outcome was the percent of days where daily average RASS was within goal. Secondary outcomes include duration of mechanical ventilation, ICU length of stay, hospital length of stay, and time to resumed home antipsychotic.


Results: A total of 52 patients were included in the primary analysis, 24 of which were resumed on their home antipsychotic within 24 hours. Fifty two percent of the cohort were male with a median age of 81.9 years. Patients who resumed their home antipsychotics within 24 hours had a-numerically higher percent of days spent within RASS goal compared to the patients who were resumed greater than 24 hours (mean 72.8% vs 67.6%, p= 0.48). However, these patients had a longer length of hospitalization (median 18 days vs 12 days, p= 0.02) and an equivalent length of ICU stay (median 8 days), and duration of mechanical ventilation (median 5 days).


Conclusions: The results of this study demonstrate that patients who were resumed on home antipsychotics within 24 hours were more likely to achieve sedation goals, but may have an increased length of hospital stay.