March - 2012
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Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: A randomized controlled trialWang, Wei MD; Li, Hong-Liang MD; Wang, Dong-Xin MD, PhD; Zhu, Xi MD; Li, Shuang-Ling MD; Yao, Gai-Qi MD; Chen, Kai-Sheng MD; Gu, Xiu-E RN, BSN; Zhu, Sai-Nan MS Critical Care Medicine, 2012, Vol 40;(3):731 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
March |
Previous Comments
| Overall, this study seems quite interesting and promising. Its a well conducted randomised controlled trial. The outcome, incidence of delirium at day 7, measured by the CAM-ICU method, is significantly reduced. If this is a true result, it is potentially of great benefit. I guess the major issues are whether or not this is a real outcome, or whether the haloperidol simply masks delirium features in the early days, and subsequent poor outcomes (such as mortality and cognitive capacity over the long term) may be unchanged. This will be difficult to know until longer, larger trials are performed. The other question will be whether or not this can be translated to general practice, or is there something specific about this context - ethnicity, analgesia / sedation practices, surgery types - or casemix (does it apply to trauma patients? Cardiothoracic and neurosurgical patients? General Medical patients?) | |
| Todd Fraser-20 Mar, 2012 11:55:20 AM | |
| The other interesting thing is the lower incidence than what they'd expected based on their previous work. The authors state that this might have been because they were a different casemix (though this doesn't appear significant to me), they used a different method for measuring delirium (which possibly did), or that they had employed a range of non-pharmacological approaches to delirium prevention (which probably did). While a magic pharmacological bullet is very appealing, I suspect the more likely scenario is that a bundle of both pharmacological and environmental interventions is required. | |
| Jo Butler-20 Mar, 2012 12:10:14 PM | |
| These are actually more HDU type patients than ICU - over half were sent to the ward within 24 hours, and with a mean APACHE 2 of 9, they're not really that sick. | |
| Jean Bridie-20 Mar, 2012 02:24:58 PM | |
Comment
For such a common complication of ICU care, the evidence base surrounding management of delirium in ICU is incredibly sparse.
This trial contributes significantly to our knowledge on the problem, examining the impact of prophylactic haloperidol to prevent delirium...