Delirium is characterized by an acute onset of confusion and altered level of consciousness that fluctuate during the day1. The incidence of delirium in intensive care (ICU) patients is as high as 80% and is associated with prolonged duration of mechanical ventilation, increased ICU/hospital length of stay and increased mortality.2-6 Therefore, preventive treatment for delirium may be necessary. One recent study, that did not perform risk stratification, showed that haloperidol prophylaxis in non-cardiac surgical ICU patients had a great impact on delirium incidence and delirium duration.7
Van den Boogaard and colleagues8 just published another delirium prophylaxis study but while using a recently developed and validated delirium prediction model that can identify ICU patients at high risk for developing delirium.9 The study is a before-after study evaluating a delirium prevention policy using prophylactic treatment with haloperidol (1 mg/8 h). The study involved those patients with a predicted risk for delirium of ≥ 50%, or with a history of alcohol abuse or dementia.
The authors showed that 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. In addition, 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). The only side effects that were reported include QTc-time prolongation (n=9), renal failure (n = 1) and suspected neurological side effects (n = 2).
The authors concluded that prophylactic haloperidol in critically ill patients with a high risk for delirium might be beneficial. Randomized, controlled trials are needed to confirm such findings.
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4 edition. Washington, DC: American Psychiatric Association; 1994.
2. 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.
3. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001;27:1892-1900.
4. Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007;33:66-73.
5. van den Boogaard M, Schoonhoven L, van der Hoeven JG, et al. Incidence and short-term consequences of delirium in critically ill patients: a prospective observational cohort study. Int J Nurs Stud 2012;49:775-783.
6. 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;14:168-169.
7. 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;11:1-9.
8. Van den Boogard M, Schoonhoven L, Achterberg T, et al. Critical Care 2013;17:R9 ...