Preventing Postoperative Delirium After Major Noncardiac Thoracic Surgery—A Randomized Clinical Trial

Abstract

Objectives To assess the efficacy of haloperidol in reducing postoperative delirium in individuals undergoing thoracic surgery. Design Randomized double‐blind placebo‐controlled trial. Setting Surgical intensive care unit (ICU) of tertiary care center. Participants Individuals undergoing thoracic surgery (N=135). Intervention Low‐dose intravenous haloperidol (0.5 mg three times daily for a total of 11 doses) administered postoperatively. Measurements The primary outcome was delirium incidence during hospitalization. Secondary outcomes were time to delirium, delirium duration, delirium severity, and ICU and hospital length of stay. Delirium was assessed using the Confusion Assessment Method for the ICU and delirium severity using the Delirium Rating Scale‐Revised. Results Sixty‐eight participants were randomized to receive haloperidol and 67 placebo. No significant differences were observed between those receiving haloperidol and those receiving placebo in incident delirium (n=15 (22.1%) vs n=19 (28.4%); p = .43), time to delirium (p = .43), delirium duration (median 1 day, interquartile range (IQR) 1‐2 days vs median 1 day, IQR 1‐2 days; p = .71), delirium severity, ICU length of stay (median 2.2 days, IQR 1–3.3 days vs median 2.3 days, IQR 1‐4 days; p = .29), or hospital length of stay (median 10 days, IQR 8–11.5 days vs median 10 days, IQR 8‐12 days; p = .41). In the esophagectomy subgroup (n = 84), the haloperidol group was less likely to experience incident delirium (n=10 (23.8%) vs n=17 (40.5%); p = .16). There were no differences in time to delirium (p = .14), delirium duration (median 1 day, IQR 1‐2 days vs median 1 day, IQR 1‐2 days; p = .71), delirium severity, or hospital length of stay (median 11 days, IQR 10‐12 days vs median days 11, IQR 10‐15 days; p = .26). ICU length of stay was significantly shorter in the haloperidol group (median 2.8 days, IQR 1.1–3.8 days vs median 3.1 days, IQR 2.1–5.1 days; p = .03). Safety events were comparable between the groups. Conclusion Low‐dose postoperative haloperidol did not reduce delirium in individuals undergoing thoracic surgery but may be efficacious in those undergoing esophagectomy. J Am Geriatr Soc 66:2289–2297, 2018.

Pharmacogenomic response of low dose haloperidol in critically ill adults with delirium

“…Haloperidol is frequently administered to critically ill adults to prevent and/or treat delirium despite evidence from randomized, controlled trials that it neither prevents or resolves delirium nor improves important outcomes like mortality or post-intensive care unit (ICU) cognition [1][2][3][4][5]. The authors of the REDUCE trial where intravenous haloperidol (up to 8 mg daily) was administered to prevent delirium in the ICU postulate low haloperidol serum concentrations may have influenced the lack of benefit with haloperidol they observed [6].…”

Incidencia del <i>delirium</i> postoperatorio en pacientes que ingresan a la Unidad de Terapia Intensiva (UTI) del Hospital Ángeles Pedregal

“…Los opioides han sido desde hace mucho tiempo una de las piedras angulares en la analgesia postoperatoria. 19 La cantidad de opioide que se administra a un paciente durante el periodo perioperatorio se ha vinculado con el desarrollo de DPO, debido a que estos fármacos son capaces de alterar la recaptura de dopamina en el núcleo accumbens, ya que aumentan la liberación de dopamina a través de la activación de los receptores mu localizados Tabla 3: Mortalidad y días de estancia en pacientes con delirium (UTI-HAP, 2018-2019).…”

Effect of Delirium on Physical Function in Noncardiac Thoracic Surgery Patients

“…We conducted a secondary analysis of data from a previously reported randomized controlled trial comparing scheduled low-dose haloperidol versus placebo for prevention of delirium in patients who had undergone major noncardiac thoracic surgery. 2 The study was conducted at a tertiary care center from September 2013 to December 2015 and was approved by the Indiana University institutional review board.…”

“…D elirium occurs in nearly 50% of patients undergoing noncardiac thoracic surgery. [1][2][3] In cardiac surgery patients, delirium is associated with decreased physical function, increasing the risk of institutionalization. 4 Patients experiencing postoperative delirium after transcatheter or surgical aortic valve replacement had decreased physical function at 1 month.…”

“…10] vs 7[6][7][8][9][10], P = .04) and the ICU (3[2][3][4][5][6] vs 2 [1-3], P = .01). Patients in the delirium group had a longer mean (SD) duration of surgery in minutes (272.1 [86.9] vs 211.9 [92.3], P = .03).…”