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Intensive Care Med. 2018 Jul;44(7):1081-1089. doi: 10.1007/s00134-018-5204-y. Epub 2018 May 16.

Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study.

Collaborators (165)

Agrifoglio A, Patruno A, Kalioubie AE, Lautrette A, Miguel A, Molinari AF, Toniolo A, Rodt AP, Skafte AA, Nissen AK, Naharro A, Berg AMN, Estébanez, García B, Encina B, Bundgaard BS, Rossen BS, Sjoeboe BA, Díaz C, Bäckman C, Leggieri C, de Cabo CM, Pavo-Galán C, Gutiérrez C, Tingsvik C, Rousseau C, Kjer CKW, Almeida C, Cantaroni C, de Oliveira CC, Escudero, Pretorius D, Hees D, Manzanedo D, Mamaev D, Christensen D, Skorstad EM, Lappi E, Wiborg E, Siven E, Perecmanis E, Sauter E, De Lucas EH, Cabeza EF, Aakerman E, Lovisari F, Vagginelli F, Näsström F, Schiöler F, Moreno-Gonzalez G, Martelli G, Gimeno G, Tanaskovic G, Ramos GV, Abusdal G, Aagaard G, Jensen HI, Knudsen H, Bundgaard H, Hoffmeyer H, Torrado H, Aguirre-Bermeo H, Pérez-Moltó H, Jara, de Haas I, Baerentsen ID, Finnstroem IJ, Greve IE, Ceniceros I, Savia I, Astola I, Elkjaer JM, Mira JP, Palm JL, Soini J, Olsson JE, Nyberg J, Heinonen J, Alonso J, García JMG, Masclans JR, Goyeneche JM, Corral JM, Pilypaite J, Bye K, Saarinen K, Wian KA, Weber K, Donadello K, Kangas K, Simons KS, Lundholm L, Malchiodi L, Álvarez L, Han-Byul L, Rabello LSCF, von Holck L, Loisa P, Buus L, Christensen LJ, Dall'ara L, Melkersson L, Orwelius L, De Crop L, Antoine M, Santafé M, Sánchez M, Blackwell ML, Cronhjort M, Martínez M, Martín-Delgado MC, Levin M, Maus M, Henry-Lagarrigue M, Romera MA, Välimäki M, Bernal MH, Ramon N, Baeza N, Maquigneau N, Marin N, Moeller-Nielsen N, Terzi N, Glerup O, Vinorum O, Inkinen O, Hild P, Miquel-Diego P, Rood P, de Azambuja Rodrigues PM, Ernoe PE, Baadstoeloekken PM, Holm P, Haltia P, Ferrer R, Hansen R, Yano R, Medici R, da Silva RTA, Smonig R, Frederiksen R, Sardo S, Sutinen S, Kentala S, Besset S, Sant'Anna ST Jr, Rodríguez S, Zambelli SE, Contreras S, Pedersen S, Hüfner S, Leggio S, Balsliemke S, Gaudry S, Estrup S, Temprano S, Nielsen S, van Zuylen T, Suhonen T, Melms T, Heinicke T, Zinzoni V, Blázquez-Alcaide V, Jørgensen VL, Collado Z.

Author information

1
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. marie.oxenboell-collet@regionh.dk.
2
Centre for Research in Intensive Care, Copenhagen, Denmark. marie.oxenboell-collet@regionh.dk.
3
Hospital Universitari Arnau de Vilanova de Lleida-IRBLleida, Hospital Universitari Vall d'Hebron-VHIR, Universitat Autònoma de Barcelona-UAB, Barcelona, Spain.
4
Department of Intensive Care Medicine and Infectious Diseases, Bichat Claude Bernard Hospital, AP-HP, Paris, France.
5
UMR1148, LVTS, Sorbonne Paris Cité, Inserm/Paris Diderot University, Paris, France.
6
National Institute of Infectious Disease, Oswaldo Cruz Foundation, Ministry of Health, Rio de Janeiro, Brazil.
7
Department of Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany.
8
Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany.
9
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
10
Division of Emergencies and Intensive Care, Oslo University Hospital, Oslo, Norway.
11
Neuroanaesthesia and Neurointensive Care, School of Medicine and Surgery, H San Gerardo Monza, University of Milano Bicocca, Milan, Italy.
12
Department Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
13
Division of Intensive Care, Department of Anaesthesia, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
14
Department of Intensive Care Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
15
Intensive Care Unit, University Hospital Gent, Ghent, Belgium.
16
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
17
Florence Nightingale Faculty of Nursing, Midwife and Palliative Care, King's College London, London, UK.
18
Centre for Research in Intensive Care, Copenhagen, Denmark.
19
Copenhagen Trial Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
20
Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
21
Centre for Statistical Science, Peking University, Beijing, China.
22
Department of Intensive Care, University Hospital Aarhus, Aarhus, Denmark.
23
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Abstract

PURPOSE:

We assessed the prevalence and variables associated with haloperidol use for delirium in ICU patients and explored any associations of haloperidol use with 90-day mortality.

METHODS:

All acutely admitted, adult ICU patients were screened during a 2-week inception period. We followed the patient throughout their ICU stay and assessed 90-day mortality. We assessed patients and their variables in the first 24 and 72 h in ICU and studied their association together with that of ICU characteristics with haloperidol use.

RESULTS:

We included 1260 patients from 99 ICUs in 13 countries. Delirium occurred in 314/1260 patients [25% (95% confidence interval 23-27)] of whom 145 received haloperidol [46% (41-52)]. Other interventions for delirium were benzodiazepines in 36% (31-42), dexmedetomidine in 21% (17-26), quetiapine in 19% (14-23) and olanzapine in 9% (6-12) of the patients with delirium. In the first 24 h in the ICU, all subtypes of delirium [hyperactive, adjusted odds ratio (aOR) 29.7 (12.9-74.5); mixed 10.0 (5.0-20.2); hypoactive 3.0 (1.2-6.7)] and circulatory support 2.7 (1.7-4.3) were associated with haloperidol use. At 72 h after ICU admission, circulatory support remained associated with subsequent use of haloperidol, aOR 2.6 (1.1-6.9). Haloperidol use within 0-24 h and within 0-72 h of ICU admission was not associated with 90-day mortality [aOR 1.2 (0.5-2.5); p = 0.66] and [aOR 1.9 (1.0-3.9); p = 0.07], respectively.

CONCLUSIONS:

In our study, haloperidol was the main pharmacological agent used for delirium in adult patients regardless of delirium subtype. Benzodiazepines, other anti-psychotics and dexmedetomidine were other frequently used agents. Haloperidol use was not statistically significantly associated with increased 90-day mortality.

KEYWORDS:

Cohort; Critical care; Delirium; Haloperidol; ICU

PMID:
29767323
DOI:
10.1007/s00134-018-5204-y
[Indexed for MEDLINE]

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