Sedation, analgesia & delirium · Treating delirium
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness
| Design | Phase 3, randomised, double-blind, placebo-controlled trial |
|---|---|
| Treatment | Haloperidol, or ziprasidone |
| Control | Placebo |
| Population | 566 patients with acute respiratory failure or shock who developed delirium; 89% hypoactive and 11% hyperactive |
| Follow-up | 90 days |
| Primary endpoint | Number of days alive without delirium or coma during the 14-day intervention period |
| Result | Neither haloperidol nor ziprasidone significantly altered the duration of delirium compared with placebo. Delirium developed in 566 of 1183 consented patients (48%). |
| Secondary endpoints | Ventilator-free days, ICU and hospital length of stay, 30-day and 90-day mortality |
The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium.
The trial authors, in the published abstract
Notable for what it reveals about the disease as much as the drug: 89% of the delirium was hypoactive, the form clinicians most often miss and least often think to sedate. Reinforced by AID-ICU four years later.
Girard TD, Exline MC, Carson SS, et al. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med 2018 Dec 27;379(26):2506-2516.