Clinical

Use of antipsychotics to treat delirium in the ICU


 

Background: Delirium is commonly seen in the ICU and has been associated with increased morbidity and mortality. While haloperidol, as well as atypical antipsychotics, often are used to manage ICU delirium, evidence has been mixed as to whether these medications shorten the duration of either hyperactive or hypoactive delirium.

Study design: Randomized, controlled trial.

Setting: 16 medical centers in the United States.

Synopsis: 566 adult patients with respiratory failure or shock who experienced delirium in medical or surgical ICUs in participating hospitals were randomly assigned to receive either IV haloperidol, ziprasidone, or placebo. The median exposure to the trial medication or placebo was 4 days. The median number of days without delirium was not significantly different among the three groups (P = .26) with a median length of delirium of 8.5 days in the placebo group, compared with 7.9 days in the haloperidol group and 8.7 days in the ziprasidone group. The study was powered to detect a 2-day difference.

Only 11% of patients experienced hyperactive delirium, which makes these results less generalizable to patients whose delirium presents as agitation.

Bottom line: The use of antipsychotics in ICU delirium does not affect the duration of delirium in patient with respiratory failure or shock.

Citation: Girard TD et al. Haloperidol and ziprasidone for treatment of delirium in critical illness. N Eng J Med. 2018 Dec 27;379(26):2506-16.

Dr. Defoe is an instructor of medicine at Northwestern University Feinberg School of Medicine and a hospitalist at Northwestern Memorial Hospital, both in Chicago.

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