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Haloperidol prophylaxis in critically ill patients with a high risk for delirium.
Crit Care 2013; 17(1):R9CC

Abstract

INTRODUCTION

Delirium is associated with increased morbidity and mortality. We implemented a delirium prevention policy in intensive care unit (ICU) patients with a high risk of developing delirium, and evaluated if our policy resulted in quality improvement of relevant delirium outcome measures.

METHODS

This study was a before/after evaluation of a delirium prevention project using prophylactic treatment with haloperidol. Patients with a predicted risk for delirium of ≥ 50%, or with a history of alcohol abuse or dementia, were identified. According to the prevention protocol these patients received haloperidol 1 mg/8 h. Evaluation was primarily focused on delirium incidence, delirium free days without coma and 28-day mortality. Results of prophylactic treatment were compared with a historical control group and a contemporary group that did not receive haloperidol prophylaxis mainly due to non-compliance to the protocol mostly during the implementation phase.

RESULTS

In 12 months, 177 patients received haloperidol prophylaxis. Except for sepsis, patient characteristics were comparable between the prevention and the historical (n = 299) groups. Predicted chance to develop delirium was 75 ± 19% and 73 ± 22%, respectively. Haloperidol prophylaxis resulted in a lower delirium incidence (65% vs. 75%, P = 0.01), and more delirium-free-days (median 20 days (IQR 8 to 27) vs. median 13 days (3 to 27), P = 0.003) in the intervention group compared to the control group. Cox-regression analysis adjusted for sepsis showed a hazard rate of 0.80 (95% confidence interval 0.66 to 0.98) for 28-day mortality. Beneficial effects of haloperidol appeared most pronounced in the patients with the highest risk for delirium. Furthermore, haloperidol prophylaxis resulted in less ICU re-admissions (11% vs. 18%, P = 0.03) and unplanned removal of tubes/lines (12% vs. 19%, P = 0.02). Haloperidol was stopped in 12 patients because of QTc-time prolongation (n = 9), renal failure (n = 1) or suspected neurological side-effects (n = 2). No other side-effects were reported. Patients who were not treated during the intervention period (n = 59) showed similar results compared to the untreated historical control group.

CONCLUSIONS

Our evaluation study suggests that prophylactic treatment with low dose haloperidol in critically ill patients with a high risk for delirium probably has beneficial effects. These results warrant confirmation in a randomized controlled trial.

TRIAL REGISTRATION

clinicaltrial.gov Identifier: NCT01187667.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

23327295

Citation

van den Boogaard, Mark, et al. "Haloperidol Prophylaxis in Critically Ill Patients With a High Risk for Delirium." Critical Care (London, England), vol. 17, no. 1, 2013, pp. R9.
van den Boogaard M, Schoonhoven L, van Achterberg T, et al. Haloperidol prophylaxis in critically ill patients with a high risk for delirium. Crit Care. 2013;17(1):R9.
van den Boogaard, M., Schoonhoven, L., van Achterberg, T., van der Hoeven, J. G., & Pickkers, P. (2013). Haloperidol prophylaxis in critically ill patients with a high risk for delirium. Critical Care (London, England), 17(1), pp. R9. doi:10.1186/cc11933.
van den Boogaard M, et al. Haloperidol Prophylaxis in Critically Ill Patients With a High Risk for Delirium. Crit Care. 2013 Jan 17;17(1):R9. PubMed PMID: 23327295.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Haloperidol prophylaxis in critically ill patients with a high risk for delirium. AU - van den Boogaard,Mark, AU - Schoonhoven,Lisette, AU - van Achterberg,Theo, AU - van der Hoeven,Johannes G, AU - Pickkers,Peter, Y1 - 2013/01/17/ PY - 2012/08/06/received PY - 2013/01/09/accepted PY - 2013/1/19/entrez PY - 2013/1/19/pubmed PY - 2015/8/19/medline SP - R9 EP - R9 JF - Critical care (London, England) JO - Crit Care VL - 17 IS - 1 N2 - INTRODUCTION: Delirium is associated with increased morbidity and mortality. We implemented a delirium prevention policy in intensive care unit (ICU) patients with a high risk of developing delirium, and evaluated if our policy resulted in quality improvement of relevant delirium outcome measures. METHODS: This study was a before/after evaluation of a delirium prevention project using prophylactic treatment with haloperidol. Patients with a predicted risk for delirium of ≥ 50%, or with a history of alcohol abuse or dementia, were identified. According to the prevention protocol these patients received haloperidol 1 mg/8 h. Evaluation was primarily focused on delirium incidence, delirium free days without coma and 28-day mortality. Results of prophylactic treatment were compared with a historical control group and a contemporary group that did not receive haloperidol prophylaxis mainly due to non-compliance to the protocol mostly during the implementation phase. RESULTS: In 12 months, 177 patients received haloperidol prophylaxis. Except for sepsis, patient characteristics were comparable between the prevention and the historical (n = 299) groups. Predicted chance to develop delirium was 75 ± 19% and 73 ± 22%, respectively. Haloperidol prophylaxis resulted in a lower delirium incidence (65% vs. 75%, P = 0.01), and more delirium-free-days (median 20 days (IQR 8 to 27) vs. median 13 days (3 to 27), P = 0.003) in the intervention group compared to the control group. Cox-regression analysis adjusted for sepsis showed a hazard rate of 0.80 (95% confidence interval 0.66 to 0.98) for 28-day mortality. Beneficial effects of haloperidol appeared most pronounced in the patients with the highest risk for delirium. Furthermore, haloperidol prophylaxis resulted in less ICU re-admissions (11% vs. 18%, P = 0.03) and unplanned removal of tubes/lines (12% vs. 19%, P = 0.02). Haloperidol was stopped in 12 patients because of QTc-time prolongation (n = 9), renal failure (n = 1) or suspected neurological side-effects (n = 2). No other side-effects were reported. Patients who were not treated during the intervention period (n = 59) showed similar results compared to the untreated historical control group. CONCLUSIONS: Our evaluation study suggests that prophylactic treatment with low dose haloperidol in critically ill patients with a high risk for delirium probably has beneficial effects. These results warrant confirmation in a randomized controlled trial. TRIAL REGISTRATION: clinicaltrial.gov Identifier: NCT01187667. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/23327295/Haloperidol_prophylaxis_in_critically_ill_patients_with_a_high_risk_for_delirium_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc11933 DB - PRIME DP - Unbound Medicine ER -