Dexmedetomidine for the Treatment of Hyperactive Delirium Refractory to Haloperidol in Nonintubated ICU Patients: A Nonrandomized Controlled Trial*

Carrasco, Genís; Baeza, Nacho; Cabré, Lluís; Portillo, Eugenia; Gimeno, Gemma Rubio; Manzanedo, David; Calizaya, Milagros

doi:10.1097/ccm.0000000000001622

Cited by 88 publications

(64 citation statements)

References 34 publications

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“…Findings from these studies are consistent with the work of Carrasco et al (14) demonstrating the effectiveness of dexmedetomidine for improving delirium outcomes and reducing cost. Importantly, Carrasco et al specifically address the question of dexmedetomidine's utility in the treatment of non-intubated patients with hyperactive delirium.…”

supporting

confidence: 81%

“…This represents an important patient population because the consequences of over-sedation are potentially catastrophic in the absence of a secure airway. In their current work, Carrasco et al (14) show that the use of dexmedetomidine in non-intubated patients who failed treatment with haloperidol resulted in reduced time with symptoms of agitated delirium, more time at the target sedation level, and decreased overall costs of the patient stay.…”

mentioning

confidence: 99%

“…In the present study, Carrasco et al address the effectiveness of dexmedetomidine as a rescue agent for nonintubated patients with hyperactive delirium that failed treatment with haloperidol (14). In this non-randomized controlled trial, 132 non-intubated ICU patients with hyperactive delirium were enrolled, and all were initially treated with intravenous bolus haloperidol.…”

mentioning

confidence: 99%

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Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated patients

2016

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supporting

confidence: 81%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated patients

2016

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“…Dexmedetomidine was studied as a rescue therapy for nonintubated ICU patients with hyperactive delirium whose agitated delirium failed to be controlled with intravenous haloperidol. Patients receiving dexmedetomidine had fewer treatment failures, less over-sedation, a shorter ICU length of stay, and less total costs compared to haloperidol (25).…”

mentioning

confidence: 99%

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

Karren¹,

King²,

Hughes³

2016

J. Thorac. Dis.

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“…We appreciate the comments by Parker et al (1) and Knauert et al (2) concerning our recent manuscript entitled "Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated ICU patients: A non-randomized controlled trial" (3). We are agreed with the most of reviewer's considerations.…”

mentioning

confidence: 59%

Dexmedetomidine, agitated delirium, and “off-label” drugs

2016

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We appreciate the comments by Parker et al. (1) and Knauert et al. (2) concerning our recent manuscript entitled "Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated ICU patients: A non-randomized controlled trial" (3). We are agreed with the most of reviewer's considerations. However, we would like to add three reflections that may be interesting for the readers. The first relates to the current position of this alpha-2 agonist on the healthcare market. A second comment intends to respond to some interesting assertions from the reviewers that, in our opinion, could be controversial. The third and final comment is addressed to reflect on the future of the research on intensive care unit (ICU) delirium.The first comment refers to the restricted indications of dexmedetomidine in ICUs setting. This drug was approved in the United States by the Food and Drug Administration (FDA) in late 1999 for use in humans as sedation of initially intubated and mechanically ventilated patients during treatment in an ICU setting, and sedation of nonintubated patients prior to and/or during surgical and other procedures. Subsequently this agent was approved also by the European Medicines Agency (EMA) for the same restricted indications. Consequently, dexmedetomidine has been especially studied for sedation in intubated patients. It has been widely compared with standard ICU intravenous sedation (propofol, midazolam lorazepam...) (4,5). Although dexmedetomidine provided some minor advantages (such as longer adequate sedation level) compared with standard ICU sedatives, the available evidence has shown that its main advantage is the control of delirium symptoms in intubated patients (an indication that was not included by authorizing its use). Although agitated delirium in intubated patients is a major problem, in the non-intubated this problem can be even greater. This is due to two reasons. The first is the different prevalence of delirium in these populations. In our environment, agitated delirium does not exceed 8% in intubated patients whilst it is greater than 25% in non-intubated patients (6). A second reason is due to the different hazard presented by these patients. Agitated delirium in intubated patients is rarely a critical problem because the dangerous agitation can be easily treated with standard sedation (propofol, midazolam lorazepam...). Oppositely, higher risk of respiratory depression limits treatment in non-intubated subjects. We wanted to investigate the problem of agitated delirium in non-intubated patients because it represented one of the main therapeutic challenges in our ICU.Strictly speaking, the treatment of delirium with dexmedetomidine could be seen as an «off-label» indication. Off-label drug use refers to the prescription of licensed drugs for clinical indications or in a manner different from that approved by the regulatory authorities and thus not included in the approved labeling for the agents. Use of drugs for a clinical indication, in a patient po...

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Dexmedetomidine for the Treatment of Hyperactive Delirium Refractory to Haloperidol in Nonintubated ICU Patients: A Nonrandomized Controlled Trial*

Abstract: In the study conditions, dexmedetomidine shows to be useful as a rescue drug for treating agitation due to delirium in nonintubated patients in whom haloperidol has failed, and it seems to have a better effectiveness, safety, and cost-benefit profile than does haloperidol.

Cited by 88 publications

References 34 publications

Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated patients

Dexmedetomidine for the treatment of hyperactive delirium refractory to haloperidol in non-intubated patients

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

Dexmedetomidine, agitated delirium, and “off-label” drugs

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