Intensive Care Management and Outcomes of Neuroleptic Malignant Syndrome: A Single-Center Retrospective Study

TL;DR

This study examines how neuroleptic malignant syndrome is managed in intensive care units and finds that timely treatment can reduce mortality.

Contribution

The study provides a detailed analysis of ICU management and outcomes for neuroleptic malignant syndrome patients.

Findings

Most patients had altered mental status, tachycardia, and hyperthermia.

Atypical antipsychotics were the most common cause of NMS.

Early diagnosis and ICU management led to acceptable mortality rates.

Abstract

Background and Objectives: Neuroleptic malignant syndrome (NMS) is a rare but high-mortality clinical condition. The aim of this study was to describe the demographic characteristics, clinical and laboratory findings, management strategies, and clinical outcomes of adult patients with NMS treated in an adult intensive care unit. Materials and Methods: This retrospective descriptive study included adult patients admitted to a tertiary care ICU with a diagnosis of NMS. Data were obtained from medical records and included demographic characteristics, suspected NMS-related drug exposures, clinical and laboratory findings at ICU admission, disease severity indicators, treatments administered, and clinical outcomes. Continuous variables were expressed as median and interquartile range (IQR), and categorical variables as number and percentage. Results: A total of 42 patients were included. The median age was 48 years (IQR: 24.1–75.5), and 61.9% were male. Atypical antipsychotics were the most frequently implicated agents (69.0%). Altered mental status was observed in 92.9% of patients, tachycardia in 61.9%, and hyperthermia in 47.6%. Creatine kinase levels >1000 U/L were present in 57.1%, and leukocytosis in 71.4%. Mechanical ventilation was required in 59.5% of patients. Acute kidney injury developed in 31%, and continuous renal replacement therapy (CRRT) was initiated in 21.4%. Bromocriptine was administered in 54.8% of cases, dantrolene in 4.8%, and amantadine in 11.9%. The ICU mortality rate was 9.5%. Conclusions: Patients with neuroleptic malignant syndrome often present with a severe clinical course requiring advanced organ support in the intensive care unit. However, with early diagnosis and appropriate intensive care management, mortality can be maintained at acceptable levels.