Antipsychotics Don ' t Help ICU delirium

by Drew Rosielle (@drosielle)It just gets worse and worse for the idea that antipsychotics have efficacy for delirium.Last year Iposted about the RCT of haloperidol, risperidone, or placebo for delirium symptoms in ' palliative ' patients. I ' m pretty sure I called for more controlled, ' high quality, ' trials, and we are lucky enough to have another.This one is arandomized, double-blinded, registered, controlled trial of haloperidol, ziprasidone, or placebo for ICU delirium, just published in NEJM.The trial took place in a geographically diverse group of US-based intensive care units. They enrolled adult patients in medical or surgical ICUs, who had delirium detected by the CAM-ICU (a well-validated tool: lots of info on it here if you want to read more). They did something interesting - they consented patients for the study (some of them at least)before the onset of delirium.  They also did prospective, broad case-finding, using research personnel to evaluate patients twice daily to see if delirium was present or not. They did not rely on clinical personnel in the ICU to identify delirium but instead proactively found them, which is a nice touch given how under-recognized delirium can be. My sense is that they consented patients rapidly upon admission to the ICU (or their surrogate), then followed them closely to rapidly identify those who developed delirium.Once delirium was identified, patients were randomized to 2.5mg of haloperidol or 5mg of ziprasidone (or m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: delirium icu journal article rosielle Source Type: blogs