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Prophylactic haloperidol does not improve survival or prevent delirium in critically ill patients
Clinical Question
Does prophylactic haloperidol improve survival in critically patients at high risk of delirium?
Bottom line
The incidence of delirium in patients in the intensive care unit is high. Adding prophylactic haloperidol for the management of critically ill patients who are already receiving non-pharmacological delirium prevention measures does not reduce this incidence, nor does it improve survival. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Inpatient (ICU only)
Synopsis
In this multi-center trial in the Netherlands, investigators randomized delirium-free patients who were expected to stay in the intensive care unit (ICU) for at least 2 days to receive either 1 mg of haloperidol every 8 hours, 2 mg of haloperidol every 8 hours, or matching placebo intravenously. Patients with underlying neurological or psychiatric disorders or those with prolonged QTc segments on electrocardiogram were excluded. Study medications were continued for 28 days, until ICU discharge, or until delirium occurred, whichever came first. If delirium occurred, study medications were discontinued and open-label haloperidol could be used for treatment of agitation. All patients also received non-pharmacological treatments for delirium prevention including early mobilization, noise reduction, and use of hearing and visual aids. Overall, 732 patients were included in the 2 mg haloperidol group and 707 patients were included in the placebo group. After 1000 patients were recruited, an interim analysis led to discontinuation of the 1 mg haloperidol group due to futility, resulting in only 350 patients included in this group in the final analysis. The 28-day and 90-day survival rates in the 2 mg haloperidol group and the placebo group were similar: 83% at 28 days and 79% at 90 days in both groups. Additionally, number of delirium-free days, duration of mechanical ventilation, and ICU and hospital lengths of stay were also similar between groups. Notably, the incidence of delirium was high in both haloperidol and placebo groups at 33%.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Good poem
A very adverse effect associated drug being used in an off label and harmful way in the very frail elderly. So sad to see this continue after 30 + years of harm, being done.
Je ne couvre pas les nus intensifs mais cette information me servira pour mieux comprendre les patients qui sont transférés à l’etage.
During my active years we had patients with trauma and hx of alcohol abuse and some with none , the usual dose was 5 mg / 8h prn most of pt was ok with 2 dose and was very effective, these patient were in special care or ICU but intubated
The authors do not mention the reduction of seizure threshold that occurs with haloperidol, but that would appear to be another good reason not to use it routinely in the critical care setting.
delirium prevention trials are needed in medicine, so it is nice to see a high quality trial.