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Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study

Marie O. Collet| Jesús Caballero| Romain Sonneville| Fernando A. Bozza| Peter Nydahl| Anna Schandl| Hilden Wøien| Giuseppe Citerio| Mark van den Boogaard| Johanna Hästbacka| Matthias Haenggi| Kirsten Colpaert| Louise Rose| Marija Barbateskovic| Theis Lange| Aksel Jensen| Martin B. Krog| Ingrid Egerod| Helle L. Nibro| Jørn Wetterslev| Anders Perner
Original
Volume 44, Issue 7 / July , 2018

Pages 1081 - 1089

Abstract

Purpose

We assessed the prevalence and variables associated with haloperidol use for delirium in ICU patients and explored any associations of haloperidol use with 90-day mortality.

Methods

All acutely admitted, adult ICU patients were screened during a 2-week inception period. We followed the patient throughout their ICU stay and assessed 90-day mortality. We assessed patients and their variables in the first 24 and 72 h in ICU and studied their association together with that of ICU characteristics with haloperidol use.

Results

We included 1260 patients from 99 ICUs in 13 countries. Delirium occurred in 314/1260 patients [25% (95% confidence interval 23–27)] of whom 145 received haloperidol [46% (41–52)]. Other interventions for delirium were benzodiazepines in 36% (31–42), dexmedetomidine in 21% (17–26), quetiapine in 19% (14–23) and olanzapine in 9% (6–12) of the patients with delirium. In the first 24 h in the ICU, all subtypes of delirium [hyperactive, adjusted odds ratio (aOR) 29.7 (12.9–74.5); mixed 10.0 (5.0–20.2); hypoactive 3.0 (1.2–6.7)] and circulatory support 2.7 (1.7–4.3) were associated with haloperidol use. At 72 h after ICU admission, circulatory support remained associated with subsequent use of haloperidol, aOR 2.6 (1.1–6.9). Haloperidol use within 0–24 h and within 0–72 h of ICU admission was not associated with 90-day mortality [aOR 1.2 (0.5–2.5); p = 0.66] and [aOR 1.9 (1.0–3.9); p = 0.07], respectively.

Conclusions

In our study, haloperidol was the main pharmacological agent used for delirium in adult patients regardless of delirium subtype. Benzodiazepines, other anti-psychotics and dexmedetomidine were other frequently used agents. Haloperidol use was not statistically significantly associated with increased 90-day mortality.

Keywords

References

  1. Boustani M, Rudolph J, Shaughnesse M (2014) The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Med 12:141. https://doi.org/10.1186/s12916-014-0141-2
    • View reference on publisher's website
  2. Slooter AJC, Van De Leur RR, Zaal IJ (2017) Delirium in critically ill patients. Handb Clin Neurol 141:449–466. https://doi.org/10.1016/B978-0-444-63599-0.00025-9
    • View reference on publisher's website
    • View reference on PubMed
  3. Gunther ML, Morandi A, Ely EW (2008) Pathophysiology of delirium in the intensive care unit. Crit Care Clin 24:45–65. https://doi.org/10.1016/j.ccc.2007.10.002
    • View reference on publisher's website
    • View reference on PubMed
  4. Hipp DM, Ely EW (2012) Pharmacological and nonpharmacological management of delirium in critically ill patients. Neurotherapeutics 9:158–175. https://doi.org/10.1007/s13311-011-0102-9
    • View reference on publisher's website
    • View reference on PubMed
  5. Kanova M, Sklienka P, Roman K, Burda M, Janoutova J (2017) Incidence and risk factors for delirium development in ICU patients—a prospective observational study. Biomed Pap 161:187–196. https://doi.org/10.5507/bp.2017.004
    • View reference on publisher's website
  6. Peterson JF, Pun BT, Dittus RS, Thomason JW, Jackson JC, Shintani AK, Ely EW (2006) Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 54:479–484. https://doi.org/10.1111/j.1532-5415.2005.00621.x
    • View reference on publisher's website
    • View reference on PubMed
  7. Kalabalik J, Brunetti L, El-Srougy R (2014) Intensive care unit delirium: a review of the literature. J Pharm Pract 27:195–207. https://doi.org/10.1177/0897190013513804
    • View reference on publisher's website
    • View reference on PubMed
  8. Han HJ, Shintani A, Eden S, Morandi A, Solberg LM, Schnelle J, Dittus RS, Storrow AB, Ely EW (2010) Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med 56:244–252. https://doi.org/10.1016/j.annemergmed.2010.03.003
    • View reference on publisher's website
    • View reference on PubMed
  9. Salluh JI, Soares M, Teles JM et al (2010) Delirium epidemiology in critical care (DECCA): an international study. Crit Care 14:R210. https://doi.org/10.1186/cc9333
    • View reference on publisher's website
    • View reference on PubMed
  10. Lat I, McMillian W, Taylor S, Janzen JM, Papadopoulos S, Korth L, Ehtisham A, Nold J, Aqarwai S, Azocar R, Burke P (2009) The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 37:1898–1905. https://doi.org/10.1097/CCM.0b013e31819ffe38
    • View reference on publisher's website
    • View reference on PubMed
  11. Pandharipande PP, Girad TD, Jackson JC et al (2013) Long-term cognitive impairment after critical illness. New Engl J Med 369:1306–1316. https://doi.org/10.1056/NEJMoa1301372
    • View reference on publisher's website
    • View reference on PubMed
  12. Zhang Z, Pan L, Ni H (2013) Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. Gen Hosp Psychiatry 35:105–111. https://doi.org/10.1016/j.genhosppsych.2012.11.003
    • View reference on publisher's website
    • View reference on PubMed
  13. Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962
    • View reference on publisher's website
    • View reference on PubMed
  14. Sakusic A, O’Horo JC, Dziadzko M, Volha D, Ali R, Singh TD, Kashyap R, Farrell AM, Fryer JD, Petersen R, Gajic O, Rabinstein AA (2018) Potentially modifiable risk factors for long-term cognitive impairment after critical illness: a systematic review. Mayo Clin Proc 93:68–82. https://doi.org/10.1016/j.mayocp.2017.11.005
    • View reference on publisher's website
    • View reference on PubMed
  15. Jacobi J, Fraser GL, Coursin DB et al (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141
    • View reference on publisher's website
    • View reference on PubMed
  16. Barr J, Fraser GL, Puntillo K et al (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306. https://doi.org/10.1097/CCM.0b013e3182783b72
    • View reference on publisher's website
    • View reference on PubMed
  17. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349. https://doi.org/10.1016/j.ijsu.2014.07.013
    • View reference on publisher's website
  18. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370–1379
    • View reference on publisher's website
    • View reference on PubMed
  19. Marquis F, Ouimet S, Riker R, Cossette M, Skrobik Y (2007) Individual delirium symptoms: do they matter? Crit Care Med 35:2533–2537
    • View reference on publisher's website
    • View reference on PubMed
  20. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA (2003) The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract 17:31–50
    • View reference on publisher's website
    • View reference on PubMed
  21. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA (2005) Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manag 29:368–375. https://doi.org/10.1016/j.jpainsymman.2004.07.009
    • View reference on publisher's website
  22. Starmark JE, Stålhammar D, Holmgren E (1988) The reaction level scale (RLS85), manual and guidelines. Acta Neurochir (Wien) 91:12–20
    • View reference on publisher's website
  23. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The richmond agitation-sedation scale. Am J Respir Crit Care Med 166:1338–1344. https://doi.org/10.1164/rccm.2107138
    • View reference on publisher's website
    • View reference on PubMed
  24. Sessler CN, Grap MJ, Ramsay MA (2008) Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care 12:S2. https://doi.org/10.1186/cc6148
    • View reference on publisher's website
    • View reference on PubMed
  25. Riker RR, Picard JT, Fraser GL (1999) Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med 27:1325–1329
    • View reference on publisher's website
    • View reference on PubMed
  26. Devlin JW, Boleske G, Mlynarek M, Nerenze DR, Peterson E, Jankowski M, Horst HM, Zarowitz BJ (1999) Motor activity assessment scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 27:1271–1275
    • View reference on publisher's website
    • View reference on PubMed
  27. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on publisher's website
    • View reference on PubMed
  28. Krag M, Perner A, Wetterslev J, Wise MP, Borthwick M, Bendel S, McArthur C, Cook D, Nielsen N, Pelosi P, Keus F, Guttormsen AB, Moller AD, Møller MH (2015) Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acultely ill adult intensive care patients. Intensive Care Med 41:833–845. https://doi.org/10.1007/s00134-015-3725-1
  29. Granholm A, Perner A, Krag M, Hjortrup PB, Haase N, Holst LB, Marker S, Collet MO, Jensen AKG, Møller MH (2018) Development and internal validation of the simplified mortality score for the intensive care unit (SMS-ICU). Acta Anaesthesiol Scand 62:3. https://doi.org/10.1111/aas.13048
  30. Strøm T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375:475–480. https://doi.org/10.1016/S0140-6736(09)62072-9
    • View reference on publisher's website
    • View reference on PubMed
  31. Burry LD, Williamson DR, Metha S, Perreault MM, Mantas I, Mallick R, Fergusson DA, Smith O, Fan E, Dupuis S, Herridge M, Rose L (2017) Delirium and exposure to psychoactive medications in critally ill adults: a multi-centre observational study. J Crit Care 42:268–274. https://doi.org/10.1016/j.jcrc.2017.08.003
    • View reference on publisher's website
    • View reference on PubMed
  32. Ely EW, shintani A, Truman B, Speroff T, Gordon SM, Harrell FR Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. J Am Med Assoc 14:1753–1762. https://doi.org/10.1001/jama.291.14.1753
    • View reference on publisher's website
  33. Pisani MA, Araujo KLB, Murphy TE (2015) Association of cumulative dose of haloperidol with next day delirium in older medical intensive care unit patients. Crit Care Med 43:996–1002. https://doi.org/10.1097/CCM.0000000000000863
    • View reference on publisher's website
    • View reference on PubMed
  34. Haenggi M, Blum S, Brechbuehl R, Brunello A, Jakob SM, Takala J (2013) Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Intensive Care Med 39:2171–2179. https://doi.org/10.1007/s00134-013-3034-5
  35. Meyhoff TS, Krag M, Hjortrup PB, Perner A, Møller MH (2017) Use of life support in acutely admitted ICU patients. An international cohort study. Acta Anaesthesiol Scand 61:513–522. https://doi.org/10.1111/aas.12878
    • View reference on publisher's website
    • View reference on PubMed
  36. Schrijver EJM, de Graaf K, de Vries OJ, Maier AB, Nanayakkara PW (2016) Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: a systematic review of current evidence. Eur J Intern Med 27:14–23. https://doi.org/10.1016/j.ejim.2015.10.012
    • View reference on publisher's website
    • View reference on PubMed
  37. Duprey MS, Al-Qadheeb N, Roberts R, Skrobik Y, Schumaker G, Devlin JW (2016) The use of low-dose IV haloperidol is not associated with QTc prolongation: post hoc analysis of a randomized, placebo-controlled trial. Intensive Care Med 42:1818–1819. https://doi.org/10.1007/s00134-016-4512-3
  38. Berman BD (2011) Neuroleptic malignant syndrome: a review for neurohospitalists. Neurohospitalist 1:41–47. https://doi.org/10.1177/1941875210386491
    • View reference on publisher's website
    • View reference on PubMed
  39. Milbrandt EB, Kersten A, Kong L, Weissfeld LA, Clermont G, Fink MP, Angus DC (2005) Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med 33:226–229
    • View reference on publisher's website
    • View reference on PubMed
  40. Thiboutot Z, Perreault MM, Williamson DR, Rose L, Mehta S, Guenette MD, Cook D, Burry L (2016) Antipsychotic drug use and screening for delirium in mechanically ventilated patients in canadian intensive care units: an observational study. Can J Hosp Pharm 69:107–113
    • View reference on PubMed

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