Preventing ICU Subsyndromal Delirium Conversion to Delirium with Low-Dose IV Haloperidol: A Double-Blind, Placebo-Controlled Pilot Study

Critical Care Medicine

Volumn 44, Issue 3, 2016, Pages 583-591

  Al Qadheeb, Nada S ^a   Skrobik, Yoanna ^b   Schumaker, Greg ^c   Pacheco, Manuel N ^c   Roberts, Russel J ^c   Ruthazer, Robin R ^c   Devlin, John W ^a,c  

^a NORTHEASTERN UNIVERSITY   (United States)

^b MCGILL UNIVERSITY   (Canada)

^c TUFTS MEDICAL CENTER   (United States)

Author keywords

Delirium; haloperidol; prevention; randomized controlled trial

Indexed keywords

HALOPERIDOL; PLACEBO; NEUROLEPTIC AGENT;

ADULT; ARTICLE; ARTIFICIAL VENTILATION; CHECKLIST; COMPARATIVE EFFECTIVENESS; CONTROLLED STUDY; CRITICALLY ILL PATIENT; DEEP SEDATION; DELIRIUM; DOUBLE BLIND PROCEDURE; DRUG EFFICACY; DRUG SAFETY; DRUG WITHDRAWAL; EXTRAPYRAMIDAL SYMPTOM; FEMALE; HUMAN; HYPOTENSION; INTENSIVE CARE DELIRIUM SCREENING CHECKLIST; INTENSIVE CARE PSYCHOSIS; LOW DRUG DOSE; MAJOR CLINICAL STUDY; MALE; MENTAL DISEASE ASSESSMENT; MOBILIZATION; MORTALITY; PILOT STUDY; POSTOPERATIVE DELIRIUM; PRIORITY JOURNAL; PSYCHOPHARMACOTHERAPY; QT PROLONGATION; QTC INTERVAL; RANDOMIZED CONTROLLED TRIAL; SEDATION; SEDATION AGITATION SCALE; SIDE EFFECT; SUBSYNDROMAL DELIRIUM; VENTILATED PATIENT; AGED; COMA; CRITICAL ILLNESS; INTENSIVE CARE UNIT; INTRAVENOUS DRUG ADMINISTRATION; LENGTH OF STAY; MIDDLE AGED; PSYCHOMOTOR AGITATION; UNITED STATES;

ADMINISTRATION, INTRAVENOUS; ADULT; AGED; ANTIPSYCHOTIC AGENTS; COMA; CRITICAL ILLNESS; DELIRIUM; DOUBLE-BLIND METHOD; FEMALE; HALOPERIDOL; HUMANS; INTENSIVE CARE UNITS; LENGTH OF STAY; MALE; MIDDLE AGED; PILOT PROJECTS; PSYCHOMOTOR AGITATION; RESPIRATION, ARTIFICIAL; UNITED STATES;

EID: 84959237115     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0000000000001411     Document Type: Article

References (43)

1. Dubois MJ, Bergeron N, Dumont M, et al: Delirium in an intensive care unit: A study of risk factors. Intensive Care Med 2001; 27:1297-1304
2. Ely EW, Shintani A, Truman B, et al: Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291:1753-1762
3. van den Boogaard M, Schoonhoven L, Evers AW, et al: Delirium in critically ill patients: Impact on long-term health-related quality of life and cognitive functioning. Crit Care Med 2012; 40:112-118
4. Ouimet S, Riker R, Bergeron N, et al: Subsyndromal delirium in the ICU: Evidence for a disease spectrum. Intensive Care Med 2007; 33:1007-1013
5. Bergeron N, Dubois MJ, Dumont M, et al: Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med 2001; 27:859-864
6. Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306
7. Schweickert WD, Pohlman MC, Pohlman AS, et al: Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet 2009; 373:1874-1882
8. Girard TD, Kress JP, Fuchs BD, et al: Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. Lancet 2008; 371:126-134
9. Devlin JW, Al-Qadhee NS, Skrobik Y: Pharmacologic prevention and treatment of delirium in critically ill and non-critically ill hospitalised patients: A review of data from prospective, randomised studies. Best Pract Res Clin Anaesthesiol 2012; 26:289-309
10. Prakanrattana U, Prapaitrakool S: Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 2007; 35:714-719
11. Kaneka T, Cai J, Ishikura T, et al: Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery. Yonago Acta Medica 1999; 42:179
12. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al: Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: A randomized placebo-controlled study. J Am Geriatr Soc 2005; 53:1658-1666
13. Larsen KA, Kelly SE, Stern TA, et al: Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: A randomized, controlled trial. Psychosomatics 2010; 51:409-418
14. Wang W, Li HL, Wang DX, et al: Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: A randomized controlled trial. Crit Care Med 2012; 40:731-739
15. Hakim SM, Othman AI, Naoum DO: Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: A randomized trial. Anesthesiology 2012; 116:987-997
16. Mu JL, Lee A, Joynt GM: Pharmacologic agents for the prevention and treatment of delirium in patients undergoing cardiac surgery: Systematic review and metaanalysis. Crit Care Med 2015; 43:194-204
17. Zaal IJ, Devlin JW, Peelen LM, et al: A systematic review of risk factors for delirium in the ICU. Crit Care Med 2015; 43:40-47
18. Lin Y, Chen J, Wang Z: Meta-analysis of factors which influence delirium following cardiac surgery. J Card Surg 2012; 27:481-492
19. Girard TD, Pandharipande PP, Carson SS, et al; MIND Trial Investigators: Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: The MIND randomized, placebo-controlled trial. Crit Care Med 2010; 38:428-437
20. Page VJ, Ely EW, Gates S, et al: Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): A randomised, double-blind, placebo-controlled trial. Lancet Respir Med 2013; 1:515-523
21. 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:R9
22. Kher S, Roberts RJ, Garpestad E, et al: Development, implementation, and evaluation of an institutional daily awakening and spontaneous breathing trial protocol: A quality improvement project. J Intensive Care Med 2013; 28:189-197
23. Devlin JW, Marquis F, Riker RR, et al: Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Crit Care 2008; 12:R19
24. Devlin JW, Fong JJ, Schumaker G, et al: Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Crit Care Med 2007; 35:2721-2724; quiz 2725
25. Devlin JW, Roberts RJ, Fong JJ, et al: Efficacy and safety of quetiapine in critically ill patients with delirium: A prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 2010; 38:419-427
26. Riker RR, Picard JT, Fraser GL: Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999; 27:1325-1329
27. Kapur S, Remington G, Jones C, et al: High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: A PET study. Am J Psychiatry 1996; 153:948-950
28. Knaus WA, Wagner DP, Draper EA, et al: The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100:1619-1636
29. Vincent JL, Moreno R, Takala J, et al: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22:707-710
30. Jorm AF: The Informant Questionnaire on cognitive decline in the elderly (IQCODE): A review. Int Psychogeriatr 2004; 16:275-293
31. van den Boogaard M, Pickkers P, Slooter AJ, et al: Development and validation of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) delirium prediction model for intensive care patients: Observational multicentre study. BMJ 2012; 344:e420
32. Drew BJ, Ackerman MJ, Funk M, et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation: Prevention of torsade de pointes in hospital settings: A scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation 2010; 121:1047-1060
33. Gosselt AN, Slooter AJ, Boere PR, et al: Risk factors for delirium after on-pump cardiac surgery: A systematic review. Crit Care 2015; 19:R346
34. Hughes CG, Patel MB, Pandharipande PP: Pathophysiology of acute brain dysfunction: What's the cause of all this confusion Curr Opin Crit Care 2012; 18:518-526
35. Skrobik Y, Ahern S, Leblanc M, et al: Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg 2010; 111:451-463
36. Balas MC, Vasilevskis EE, Olsen KM, et al: Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med 2014; 42:1024-1036
37. Klompas M, Anderson D, Trick W, et al; CDC Prevention Epicenters: The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015; 191:292-301
38. Khan BA, Fadel WF, Tricker JL, et al: Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU. Crit Care Med 2014; 42:e791-e795
39. Shehabi Y, Grant P, Wolfenden H, et al: Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: A randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology 2009; 111:1075-1084
40. Riker RR, Shehabi Y, Bokesch PM, et al; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group: Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial. JAMA 2009; 301:489-499
41. van den Boogaard M, Slooter AJ, Brüggemann RJ, et al: Prevention of ICU delirium and delirium-related outcome with haloperidol: A study protocol for a multicenter randomized controlled trial. Trials 2013; 14:400
42. Pandharipande PP, Girard TD, Ely EW: Long-term cognitive impairment after critical illness. N Engl J Med 2014; 370:185-186
43. Jackson JC, Pandharipande PP, Girard TD, et al; Bringing to light the Risk Factors And Incidence of Neuropsychological dysfunction in ICU survivors (BRAIN-ICU) study investigators: Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: A longitudinal cohort study. Lancet Respir Med 2014; 2:369-379