Delirium Treatment Has No Benefit for Survival in Critically Ill

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Prophylactic haloperidol does not improve survival for critically ill adults at high risk of delirium.
Prophylactic haloperidol does not improve survival for critically ill adults at high risk of delirium.

HealthDay News — For critically ill adults at high risk of delirium, prophylactic haloperidol does not improve survival at 28 days compared with placebo, according to a study published online in the Journal of the American Medical Association.

In a randomized trial, Mark van den Boogaard, PhD, from the Radboud University Medical Center in Nijmegen, Netherlands, and colleagues examined whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium. A total of 1789 critically ill adults treated at 21 intensive care units (ICUs) were randomized to receive prophylactic treatment three times daily with 1 mg or 2 mg of haloperidol (350 and 732 patients, respectively), or placebo (707 patients).

Due to futility, the 1 mg haloperidol group was stopped prematurely. The researchers observed no significant difference in the median days that patients survived in 28 days (28 days for haloperidol vs 28 days for placebo). There was no statistically significant difference in any of the 15 secondary outcomes, including delirium incidence, delirium-free and coma-free days, and duration of mechanical ventilation, ICU, and hospital length of stay. There was no difference between the groups in the number of reported adverse events.

"These findings do not support the use of prophylactic haloperidol for reducing mortality in critically ill adults," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

Reference

van den Boogaard M, Slooter AJC,  Brüggemann RJM, et al. Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE randomized clinical trial. JAMA. 2018;319(7):680-690.


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