Delirium treatment in intoxicated patients in ICU: A randomized, double-blind clinical trial

Abstract

Objective: Delirium is one of the most common complications in patients admitted to intensive care units (ICUs). Delirium is a definite cause for more extended hospital stays, higher mortality rates, and possibly persistent cognitive decline in the future. Antipsychotics have been frequently evaluated as first drugs of choice, but the most appropriate, evidence-based treatment is yet to be discovered. This study aims to compare the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU. Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for delirium, and clinical toxicologists included the patients according to the study’s inclusion and exclusion criteria. Patients received either haloperidol or olanzapine based on computerized randomization. The severity of delirium was measured with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICU-admission. Results: The total sample size was 35 in which 16 patients received haloperidol, and 19 patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three times a day and 5 mg three times a day, respectively. There was no significant difference in baseline characteristics and the scores of MDAS between groups. Conclusion: Olanzapine and haloperidol have the same efficacy in the management of delirium in toxicology ICU-admitted patients. They can be interchangeably used for delirium treatment in these patients.

Olanzapine for the treatment of ICU delirium: a systematic review and meta-analysis

“…Six studies 26 , 27 , 29 – 32 reported the incidence of complications under the use of olanzapine and other interventions. The overall complication rate of the olanzapine group was 14.74% (56/380), which was lower than the rate of 27.25% (112/411) in the other intervention groups.…”

“…Six had unmeasured delirium, 31 post ICU/non-ICU occurrence, 21 study subjects nonolanzapine, 10 abstracts only, 15 reviews only, nine case/case series, 16 secondary analyses, six editorials/reviews, one descriptive study, seven terminated/incomplete, and 21 unclassified studies were excluded. Finally, nine quantitative studies (four RCTs and five retrospective cohort studies) 15,[26][27][28][29][30][31][32][33] were included. The main characteristics of the included studies are shown in Table 1.…”

“…Seven studies used CAM or CAM-ICU diagnostic criteria, 15,[28][29][30][31][32][33] and two studies used DSM-IV or DSM-5 diagnostic criteria. 26,27 All nine studies enrolled adult ICU patients. 15,[26][27][28][29][30][31][32][33] Three studies quantitatively analyzed the control of delirium severity.…”

“…Data on the improvement of delirium symptoms were explored in seven studies (three RCTs and four retrospective cohort studies). 15,26,27,29,30,32,33 However, only three studies with data on delirium symptom relief could be combined for statistical analysis. 29,32,33 The effective rates of delirium symptom improvement in the olanzapine group and other intervention groups were 64.38% (103/160) and 57.70% (90/156), respectively.…”

“…Four studies 27,30,31,33 reported data on the length of hospital stay. The summary results showed that hospital stay (days) was not significantly different between patients treated with olanzapine and other interventions (SMD = −0.22, 95% CI [−0.87, 0.20], p = 0.12, I 2 = 84%, Figure 5).…”