More than 5,000,000 patients are admitted to an intensive care unit (ICU) in the United States each year and up to 80% of these patients who are mechanically ventilated develop delirium.1,2 Delirium is often associated with poor functional recovery, more frequent complications, longer hospital stays and higher mortality. In fact, after controlling for preexisting morbidities, severity of illness, coma, and use of sedatives, patients who develop delirium in the ICU are more than 3-times as likely to be dead at 6 months compared to those patients who do not develop delirium.1-5 It is therefore critical that interventions that can prevent delirium from occurring in the ICU be discovered.
A study that was recently published by Wang and colleagues sought to evaluate the efficacy and safety of short-term low-dose intravenous haloperidol for delirium prevention in critically ill elderly patients after non-cardiac surgery. The study was prospective, randomized, double-blind, in a placebo-controlled fashion in two tertiary care hospitals. Four hundred fifty-seven patients who were admitted to the ICU after non-cardiac surgery were randomized to either haloperidol (0.5 mg intravenous bolus injection followed by continuous infusion at a rate of 0.1 mg/h for 12 hrs) or placebo. The primary end point was the incidence of delirium within the first 7 days after surgery and the secondary end points included time to onset of delirium, number of delirium-free days, length of ICU stay, all-cause 28-day mortality, and adverse events. Delirium was assessed using the confusion assessment method for the intensive care unit.6
The incidence of delirium during the first 7 days after surgery in the haloperidol group was 15.3% and was 23.2% in the control group; p = .031. The mean time to onset of delirium and the mean number of delirium-free days were significantly longer (6.2 days [95% confidence interval (CI) 5.9-6.4] vs. 5.7 days [95% CI 5.4-6.0]; p = .021; and 6.8 ± 0.5 days vs. 6.7 ± 0.8 days; p = .027, respectively). While the median length of ICU stay was significantly shorter (21.3 hrs [95% CI 20.3-22.2] vs. 23.0 hrs [95% CI 20.9-25.1]; p = .024) in the haloperidol group compared to the control group, there was no significant difference with regard to all-cause 28-day mortality between the two groups (p = .175).
This study demonstrates that short-term haloperidol prophylaxis can significantly reduce the incidence of delirium during the first 7 postoperative days. More research is clearly necessary, given the growing data supporting the use of antipsychotics for the prevention of delirium.
1. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007;33(1):66-73.
2. Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest 2007;132(2):624-636.
3. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on ...