Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial*.

Abstract

OBJECTIVES:

To evaluate the efficacy and safety of short-term low-dose intravenous haloperidol for delirium prevention in critically ill elderly patients after noncardiac surgery.

DESIGN:

Prospective, randomized, double-blind, and placebo-controlled trial in two centers.

SETTING:

Intensive care units of two large tertiary teaching hospitals.

PATIENTS:

Four hundred fifty-seven patients 65 yrs or older who were admitted to the intensive care unit after noncardiac surgery.

INTERVENTION:

Haloperidol (0.5 mg intravenous bolus injection followed by continuous infusion at a rate of 0.1 mg/h for 12 hrs; n = 229) or placebo (n = 228) was randomly administered from intensive care unit admission.

MEASURES:

The primary end point was the incidence of delirium within the first 7 days after surgery. Secondary end points included time to onset of delirium, number of delirium-free days, length of intensive care unit stay, all-cause 28-day mortality, and adverse events. Delirium was assessed using the confusion assessment method for the intensive care unit.

RESULTS:

The incidence of delirium during the first 7 days after surgery was 15.3% (35/229) in the haloperidol group and 23.2% (53/228) in the control group (p = .031). The mean time to onset of delirium and the mean number of delirium-free days were significantly longer (6.2 days [95% confidence interval 5.9-6.4] vs. 5.7 days [95% confidence interval 5.4-6.0]; p = .021; and 6.8 ± 0.5 days vs. 6.7 ± 0.8 days; p = .027, respectively), whereas the median length of intensive care unit stay was significantly shorter (21.3 hrs [95% confidence interval 20.3-22.2] vs. 23.0 hrs [95% confidence interval 20.9-25.1]; p = .024) in the haloperidol group than in the control group. There was no significant difference with regard to all-cause 28-day mortality between the two groups (0.9% [2/229] vs. 2.6% [6/228]; p = .175). No drug-related side effects were documented.

CONCLUSIONS:

For elderly patients admitted to intensive care unit after noncardiac surgery, short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of postoperative delirium. The therapy was well-tolerated.

• Authors: Wei Wang, Hong-Liang Li, Dong-Xin Wang, Xi Zhu, Shuang-Ling Li, Gai-Qi Yao, Kai-Sheng Chen, Xiu-E Gu, Sai-Nan Zhu
• Journal: Critical care medicine (Crit Care Med) Vol. 40 Issue 3 Pg. 731-9 (Mar 2012) ISSN: 1530-0293 [Electronic] United States
• PMID: 22067628 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antipsychotic Agents
• Haloperidol

Topics

• Aged
• Antipsychotic Agents (therapeutic use)
• Delirium (epidemiology, prevention & control)
• Double-Blind Method
• Female
• Haloperidol (therapeutic use)
• Humans
• Incidence
• Male
• Postoperative Complications (epidemiology, prevention & control)
• Prospective Studies