We conducted a retrospective review of the charts of advanced
cancer patients admitted to our acute
palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of
delirium and first-line treatment with
haloperidol.
RESULTS: Among 167 patients with
delirium, 128 (77%) received only
haloperidol and 39 (23%) received a second
neuroleptic. Ninety-one patients (71%) who received
haloperidol alone improved and were discharged alive. The median initial
haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final
haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for
neuroleptic rotation (87%). Significant factors associated with
neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014).
Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by
haloperidol. The median initial
chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second
neuroleptic.
CONCLUSION: