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

Author

Collet, M, Caballero, J, Sonneville, R, Bozza, F, Nydahl, P, Schandl, A, Wøien, H, Citerio, G, van den Boogaard, M, Hästbacka, J, Haenggi, M, Colpaert, K, Rose, L, Barbateskovic, M, Lange, T, Jensen, A, Krog, M, Egerod, I, Nibro, H, Wetterslev, J, Perner, A, Collet, MO, Bozza, FA, Krog, MB, Nibro, HL, Collet, M, Caballero, J, Sonneville, R, Bozza, F, Nydahl, P, Schandl, A, Wøien, H, Citerio, G, van den Boogaard, M, Hästbacka, J, Haenggi, M, Colpaert, K, Rose, L, Barbateskovic, M, Lange, T, Jensen, A, Krog, M, Egerod, I, Nibro, H, Wetterslev, J, Perner, A, Collet, MO, Bozza, FA, Krog, MB, and Nibro, HL

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

Published
2018

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

Author

Theis Lange, Jørn Wetterslev, Jesús Caballero, Ingrid Egerod, Johanna Hästbacka, Anders Perner, Hilden Wøien, Louise Rose, Marie Oxenbøll Collet, Matthias Haenggi, Mark van den Boogaard, Kirsten Colpaert, Giuseppe Citerio, Anna Schandl, Romain Sonneville, Marija Barbateskovic, Martin B. Krog, Aksel Karl Georg Jensen, Fernando A. Bozza, Helle Lykkeskov Nibro, Peter Nydahl, Department of Diagnostics and Therapeutics, Clinicum, Anestesiologian yksikkö, University of Helsinki, HYKS erva, HUS Perioperative, Intensive Care and Pain Medicine, Collet, M, Caballero, J, Sonneville, R, Bozza, F, Nydahl, P, Schandl, A, Wøien, H, Citerio, G, van den Boogaard, M, Hästbacka, J, Haenggi, M, Colpaert, K, Rose, L, Barbateskovic, M, Lange, T, Jensen, A, Krog, M, Egerod, I, Nibro, H, Wetterslev, J, and Perner, A

Subjects
TERM COGNITIVE IMPAIRMENT, Olanzapine, LEVEL, Cohort, Critical care, Delirium, Haloperidol, ICU, Adolescent, Adult, Brazil, Canada, Critical Care, Europe, Humans, Intensive Care Units, Prevalence, Prospective Studies, Risk Factors, Antipsychotic Agents, MULTICENTER, GUIDELINES, Critical Care and Intensive Care Medicine, 0302 clinical medicine, 030212 general & internal medicine, Prospective cohort study, CAM-ICU, SEDATION SCALE, 3. Good health, medicine.symptom, CRITICALLY-ILL PATIENTS, medicine.drug, medicine.medical_specialty, MECHANICALLY VENTILATED PATIENTS, 610 Medicine & health, behavioral disciplines and activities, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Intensive care, Internal medicine, medicine, Dexmedetomidine, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], 030208 emergency & critical care medicine, Odds ratio, 3126 Surgery, anesthesiology, intensive care, radiology, UNIT, Quetiapine, CRITICAL ILLNESS, business
Abstract

PurposeWe 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.MethodsAll 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.ResultsWe 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.ConclusionsIn 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.

Published
2018

6. Transfusion requirements in septic shock (TRISS) trial - comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU: protocol for a randomised controlled trial.

Author

Holst LB, Haase N, Wetterslev J, Wernerman J, Aneman A, Guttormsen AB, Johansson PI, Karlsson S, Klemenzson G, Winding R, Nebrich L, Albeck C, Vang ML, Bülow HH, Elkjær JM, Nielsen JS, Kirkegaard P, Nibro H, Lindhardt A, Strange D, Thormar K, Poulsen LM, Berezowicz P, Bådstøløkken PM, Strand K, Cronhjort M, Haunstrup E, Rian O, Oldner A, Bendtsen A, Iversen S, Langva JÅ, Johansen RB, Nielsen N, Pettilä V, Reinikainen M, Keld D, Leivdal S, Breider JM, Tjäder I, Reiter N, Gøttrup U, White J, Wiis J, Andersen LH, Steensen M, and Perner A

Subjects
Biomarkers blood, Clinical Protocols, Clinical Trials Data Monitoring Committees, Erythrocyte Transfusion adverse effects, Erythrocyte Transfusion mortality, Fluid Therapy, Hemoglobins metabolism, Humans, Iceland, Risk Assessment, Risk Factors, Scandinavian and Nordic Countries, Shock, Septic blood, Shock, Septic diagnosis, Shock, Septic mortality, Shock, Septic physiopathology, Time Factors, Treatment Outcome, Erythrocyte Transfusion methods, Intensive Care Units, Research Design, Shock, Septic therapy
Abstract

Background: Transfusion of red blood cells (RBC) is recommended in septic shock and the majority of these patients receive RBC transfusion in the intensive care unit (ICU). However, benefit and harm of RBCs have not been established in this group of high-risk patients., Methods/design: The Transfusion Requirements in Septic Shock (TRISS) trial is a multicenter trial with assessor-blinded outcome assessment, randomising 1,000 patients with septic shock in 30 Scandinavian ICUs to receive transfusion with pre-storage leuko-depleted RBC suspended in saline-adenine-glucose and mannitol (SAGM) at haemoglobin level (Hb) of 7 g/dl or 9 g/dl, stratified by the presence of haematological malignancy and centre. The primary outcome measure is 90-day mortality. Secondary outcome measures are organ failure, ischaemic events, severe adverse reactions (SARs: anaphylactic reaction, acute haemolytic reaction and transfusion-related circulatory overload, and acute lung injury) and mortality at 28 days, 6 months and 1 year.The sample size will enable us to detect a 9% absolute difference in 90-day mortality assuming a 45% event rate with a type 1 error rate of 5% and power of 80%. An interim analysis will be performed after 500 patients, and the Data Monitoring and Safety Committee will recommend the trial be stopped if a group difference in 90-day mortality with P ≤0.001 is present at this point., Discussion: The TRISS trial may bridge the gap between clinical practice and the lack of efficacy and safety data on RBC transfusion in septic shock patients. The effect of restrictive versus liberal RBC transfusion strategy on mortality, organ failure, ischaemic events and SARs will be evaluated.

Published
2013
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