Haloperidol versus placebo for delirium prevention in acutely hospitalised older at risk patients: a multi-centre double-blind randomised controlled clinical trial

Schrijver, Edmée J M; Vries, Oscar J. de; Ven, Peter M. van de; Bet, Pierre M; Kamper, A.M.; Diepeveen, S. H. A.; Marum, Rob J. van; Strien, Astrid M van; Anten, Sander; Lagaay, A. M.; Boelaarts, Leo; Bloemers, Frank W.; Kramer, Mark H. H.; Nanayakkara, Prabath W.B.

doi:10.1093/ageing/afx124

Cited by 40 publications

(34 citation statements)

References 25 publications

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“…68 A recent multicentre RCT of medical and surgical patients aged 70 yr compared the antipsychotic drug haloperidol or placebo on top of nonpharmacological strategies to prevent POD. 143 There was no difference in delirium incidence, duration, or severity. Melatonin has shown conflicting results as a preventative agent for POD in a few small RCTs.…”

Section: Preventionmentioning

confidence: 88%

“…177 Another multicentre RCT published after the meta-analysis found no effect of prophylactic haloperidol on delirium severity or duration. 143 A comparison of typical vs atypical antipsychotics did not find a consistent trend in improvement of symptoms to recommend one over another. 177 Other drugs used in the treatment of delirium include melatonin and cholinesterase inhibitors.…”

Section: Treatmentmentioning

confidence: 94%

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State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Mahanna‐Gabrielli

Schenning

Eriksson

et al. 2019

British Journal of Anaesthesia

168

187

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Cognitive recovery after anaesthesia and surgery is a concern for older adults, their families, and caregivers. Reports of patients who were 'never the same' prompted a scientific inquiry into the nature of what patients have experienced. In June 2018, the ASA Brain Health Initiative held a summit to discuss the state of the science on perioperative cognition, and to create an implementation plan for patients and providers leveraging the current evidence. This group included representatives from the AARP (Area. This paper summarises the state of the relevant clinical science, including risk factors, identification and diagnosis, prognosis, disparities, outcomes, and treatment of perioperative neurocognitive disorders. Finally, we discuss gaps in current knowledge with suggestions for future directions and opportunities for clinical and translational projects.

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Section: Preventionmentioning

confidence: 88%

Section: Treatmentmentioning

confidence: 94%

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Mahanna‐Gabrielli

Schenning

Eriksson

et al. 2019

British Journal of Anaesthesia

168

187

View full text Add to dashboard Cite

show abstract

“…21 The HARPOON study randomized 245 acutely hospitalized elderly patients to prophylactic haloperidol versus placebo and found no clear differences in delirium incidence, duration, severity, or 3-month mortality. 117 The MIND-USA study compared haloperidol, ziprasidone, and placebo in a randomized, double-blind trial and found no effect of either antipsychotic medication on the number of coma-free and delirium-free days (►Fig. 3).…”

Section: Changing Perspectives On Antipsychoticsmentioning

confidence: 99%

Prevention and Management of Delirium in the Intensive Care Unit

Mart

Roberson

Salas

et al. 2020

Semin Respir Crit Care Med

105

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Delirium is a debilitating form of brain dysfunction frequently encountered in the intensive care unit (ICU). It is associated with increased morbidity and mortality, longer lengths of stay, higher hospital costs, and cognitive impairment that persists long after hospital discharge. Predisposing factors include smoking, hypertension, cardiac disease, sepsis, and premorbid dementia. Precipitating factors include respiratory failure and shock, metabolic disturbances, prolonged mechanical ventilation, pain, immobility, and sedatives and adverse environmental conditions impairing vision, hearing, and sleep. Historically, antipsychotic medications were the mainstay of delirium treatment in the critically ill. Based on more recent literature, the current Society of Critical Care Medicine (SCCM) guidelines suggest against routine use of antipsychotics for delirium in critically ill adults. Other pharmacologic interventions (e.g., dexmedetomidine) are under investigation and their impact is not yet clear. Nonpharmacologic interventions thus remain the cornerstone of delirium management. This approach is summarized in the ABCDEF bundle (Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment). The implementation of this bundle reduces the odds of developing delirium and the chances of needing mechanical ventilation, yet there are challenges to its implementation. There is an urgent need for ongoing studies to more effectively mitigate risk factors and to better understand the pathobiology underlying ICU delirium so as to identify additional potential treatments. Further refinements of therapeutic options, from drugs to rehabilitation, are current areas ripe for study to improve the short- and long-term outcomes of critically ill patients with delirium.

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“…Interventions aimed at reducing the incidence and severity of delirium have been studied in various settings, but our preliminary searches revealed a paucity of ED research. 15 Multicomponent prevention programmes in hospitalised patients showed a reduction in delirium incidence. 16 17 Several Cochrane reviews have been published since 2012, which reported the utility of pharmacological agents, 18 19 delirium prevention programmes in hospital setting 16 and long-term care.…”

Section: Introductionmentioning

confidence: 99%

Delirium prevention and treatment in the emergency department (ED): a systematic review protocol

et al. 2020

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IntroductionDelirium is a dangerous syndrome of acute brain dysfunction that is common in the emergency department (ED), especially among the geriatric population. Most systematic reviews of interventions for delirium prevention and treatment have focused on inpatient settings. Best practices of effective delirium care in ED settings have not been established. The primary objective of this study is to identify pharmacologic and non-pharmacologic interventions as applied by physicians, nursing staff, pharmacists and other ED personnel to prevent incident delirium and to shorten the severity and duration of prevalent delirium in a geriatric population within the ED.Methods and analysisSearches using subject headings and keywords will be conducted from database inception through June 2020 in MEDLINE, EMBASE, Web of Science, PsychINFO, CINAHL, ProQuest Dissertations and Theses Global and Cochrane CENTRAL as well as grey literature. Database searches will not be limited by date or language. Two reviewers will identify studies describing any interventions for delirium prevention and/or treatment in the ED. Disagreements will be settled by a third reviewer. Pooled data analysis will be performed where possible using Review Manager. Risk ratios and weighted difference of means will be used for incidence of delirium and other binary outcomes related to delirium, delirium severity or duration of symptoms, along with 95% CIs. Heterogeneity will be measured by calculating I2, and a forest plot will be created. If significant heterogeneity is identified, metaregression is planned using OpenMeta to identify possible sources of heterogeneity.Ethics and disseminationThis is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. This review will be prepared as a manuscript and submitted for publication to a peer-reviewed journal, and the results will be presented at conferences.PROSPERO trial registration numberCRD42020169654.

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Haloperidol versus placebo for delirium prevention in acutely hospitalised older at risk patients: a multi-centre double-blind randomised controlled clinical trial

Abstract: prophylactic low-dose oral haloperidol did not reduce delirium incidence in acutely hospitalised older patients. Therefore, prophylactic use of haloperidol in this population is not recommended.

Cited by 40 publications

References 25 publications

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

State of the clinical science of perioperative brain health: report from the American Society of Anesthesiologists Brain Health Initiative Summit 2018

Prevention and Management of Delirium in the Intensive Care Unit

Delirium prevention and treatment in the emergency department (ED): a systematic review protocol

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