Haloperidol prophylaxis in critically ill patients with a high risk for delirium

Boogaard, Mark van den; Schoonhoven, Lisette; Achterberg, Theo van; Hoeven, Johannes G. van der; Pickkers, Peter

doi:10.1186/cc11933

Cited by 111 publications

(72 citation statements)

References 34 publications

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“…This effect was most pronounced in very high risk patients. A multicentre study on that strategy has just been completed and is awaiting final analyses [22]. Experiences from perioperative care in VOPs also suggest that preoperative prophylaxis with haloperiodol [23] and recently with dexmedetomidine [24] also may be effective.…”

Section: Deliriummentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

212

196

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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Section: Deliriummentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

212

196

View full text Add to dashboard Cite

show abstract

“…Since the lack of evidence about the efficacy of typical versus atypical antipsychotics, Ely et al are conducting the MIND-USA (Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) Study (ClinicalTrials.gov Identifier NCT01211522) to define the role of this drugs in the management of delirium and on short- and long-term clinical outcomes in vulnerable critically ill patients (61). Delirium prophylaxis with medications is discouraged in the PAD guidelines, but recent small studies on delirium prophylaxis with antipsychotics showed that a low-dose of haloperidol may reduce the incidence of delirium in ICU patients (62, 63). By contrast, the HOPE-ICU randomized controlled trial showed no benefit of haloperidol administration for delirium prophylaxis in a mixed population of medical and surgical adult ICU patients (64).…”

Section: Deliriummentioning

confidence: 99%

Intensive Care Unit Delirium and Intensive Care Unit–Related Posttraumatic Stress Disorder

Marra

Pandharipande

Patel

2017

Surgical Clinics of North America

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SYNOPSIS Delirium is one of the most common behavioral manifestations of acute brain dysfunction in Intensive Care Unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools (e.g., CAM-ICU, ICDSC). In delirious patients, a search for all reversible precipitants is the first line of action and pharmacological treatment should be considered when all causes have been ruled out, and not contraindicated. Long-term morbidity, in the forms of cognitive, physical and psychological impairments, has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop PTSD anchored to their critical illness experience, with ICU-related PTSD incidence rates of 10%. Using ICU diaries during a critical illness may minimize the occurrence of future ICU-related PTSD.

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“…Antipsychotic administration in the ICU is controversial (9, 19-21) and has not been studied in critically ill patients with subsyndromal delirium. One single-center, uncontrolled, before-after analysis suggested that the administration of haloperidol throughout the period of critical illness may reduce delirium and lower mortality (19).…”

Section: Introductionmentioning

confidence: 99%

Preventing ICU Subsyndromal Delirium Conversion to Delirium With Low-Dose IV Haloperidol

Al-Qadheeb

Skrobik

Schumaker

et al. 2016

Critical Care Medicine

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Objective To compare the efficacy and safety of scheduled low-dose, haloperidol vs. placebo for the prevention of delirium [Intensive Care Delirium Screening Checklist (ICDSC) ≥ 4)] administered to critically ill adults with subsyndromal delirium (ICDSC = 1-3). Design Randomized, double-blind, placebo-controlled trial. Setting Three 10-bed ICUs (2 medical; 1 surgical) at an academic medical center in the U.S. Patients Sixty-eight mechanically ventilated patients with subsyndromal delirium without complicating neurologic conditions, cardiac surgery or requiring deep sedation. Interventions Patients were randomly assigned to receive intravenous haloperidol 1 mg or placebo every six hours until either delirium (ICDSC ≥ 4 with psychiatric confirmation), therapy ≥ 10 days or ICU discharge occurred. Measurements and Main Results Baseline characteristics were similar between the haloperidol (n=34) and placebo (n=34) groups. A similar number of patients given haloperidol [12/34 (35%)] and placebo [8/34 (23%)] patients developed delirium (p=0.29). Haloperidol use reduced the hours per study day spent agitated (SAS ≥ 5) (p=0.008), but did not influence the proportion of 12-hour ICU shifts patients’ spent alive without coma (SAS ≤ 2) or delirium (p=0.36), the time to first delirium occurrence (p=0.22) nor delirium duration (p=0.26). Days of mechanical ventilation (p=0.80), ICU mortality (p=0.55) and ICU patient disposition (p=0.22) were similar in the two groups. The proportion of patients who developed QTc-interval prolongation (p=0.16), extrapyramidal symptoms (p=0.31), excessive sedation (p=0.31) or new-onset hypotension (p=1.0) that resulted in study drug discontinuation was comparable between the two groups. Conclusions Low-dose scheduled haloperidol, initiated early in the ICU stay, does not prevent delirium and has little therapeutic advantage in mechanically ventilated, critically ill adults with subsyndromal delirium.

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Haloperidol prophylaxis in critically ill patients with a high risk for delirium

Cited by 111 publications

References 34 publications

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Intensive Care Unit Delirium and Intensive Care Unit–Related Posttraumatic Stress Disorder

Preventing ICU Subsyndromal Delirium Conversion to Delirium With Low-Dose IV Haloperidol

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