Sedation, analgesia & delirium · Treating delirium
Haloperidol for the Treatment of Delirium in ICU Patients
| Design | Multicentre, blinded, placebo-controlled randomised trial |
|---|---|
| Treatment | Haloperidol |
| Control | Placebo |
| Population | 987 analysed ICU patients with delirium |
| Follow-up | 90 days |
| Primary endpoint | Days alive and out of hospital at 90 days |
| Result | Haloperidol did not lead to significantly more days alive and out of hospital at 90 days than placebo, among 501 and 486 patients respectively. Mortality at 90 days was 36.3% with haloperidol and 43.3% with placebo — adjusted absolute difference -6.9 percentage points (95% CI -13.0 to -0.6), a secondary outcome not adjusted for multiplicity. |
| Secondary endpoints | Mortality, serious adverse reactions, days with delirium or coma |
Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo.
The trial authors, in the published abstract
Concordant with MIND-USA, and between them they removed the pharmacological treatment of ICU delirium from evidence-based practice. Haloperidol still has a role in managing dangerous agitation; it does not treat the delirium.
Andersen-Ranberg NC, Poulsen LM, Perner A, et al. Haloperidol for the Treatment of Delirium in ICU Patients. N Engl J Med 2022 Dec 29;387(26):2425-2435.