Study Finds No Benefit To Prophylactic Haldol For Delirium in ICU

MedicalResearch.com Interview with:
“hospital.” by Bethany Satterfield is licensed under CC BY 2.0
Mark van den Boogaard, PhD, RN, CCRN
Assistant Professor
Department of Intensive Care Medicine
Radboud University Medical Center
Nijmegen Netherlands 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Delirium is affecting many of our intensive care unit (ICU) patients which is impacting their recovery on the short-term as well as on the long-term. Therefore we were very interested to investigate if the use prophylactic haloperidol would be beneficial for the ICU patients. Especially because there were indications that it would be effective in ICU delirium prevention and also because this drug is being used in daily practice to prevent ICU delirium although there is no clear evidence. The overall finding of our large-scale well designed study is that we didn’t find any beneficial effect of prophylactic haloperidol in ICU patients. Moreover, this finding is very consistent over all groups of patients. 

MedicalResearch.com: What should readers take away from your report?

Response: The take away message is that there is no indication, no reason to prescribe prophylactic haloperidol for intensive care unit patients. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We recommend to stop the use of prophylactic haloperidol in ICU patients. This is really important because we know from other studies that this is still common practice in several ICUs in the USA and Canada (see studies from Burry, LD, et al. in journal of critical care, 2017 and Mo, Y et al. in journal pharmaceutical practice, 2017) This recommendation contributes to reduce polypharmacy in the intensive care unit. 

MedicalResearch.com: Is there anything else you would like to add?

Response: We cannot rule out that other anti-psychotics agents may have beneficial effects. However, based on other studies we believe that the use of non-pharmacological preventive interventions, like early mobilization, cognitive training, reducing noise, improving patients visibility and hearing, are probably more effective especially when this is offered as a bundle of interventions (multicomponent interventions). But this need to be investigated, and confirmed in a well designed large-scale study.

Citations 

van den Boogaard M, Slooter AJC, Brüggemann RJM, Schoonhoven L, Beishuizen A, Vermeijden JW, Pretorius D, de Koning J, Simons KS, Dennesen PJW, Van der Voort PHJ, Houterman S, van der Hoeven JG, Pickkers P, . Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of DeliriumThe REDUCE Randomized Clinical TrialJAMA. 2018;319(7):680–690. doi:10.1001/jama.2018.0160

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