Managing Persistent Agitation in Patients with Terminal Delirium

Unlike acute delirium in hospitalized patients, terminal delirium typically is resistant to nonpharmacologic interventions and is irreversible. For patients with terminal delirium, clinical focus shifts from reversing delirium to controlling agitation, ensuring patient comfort, and minimizing distress for patients and their families. Physicians treating patients with delirium at the end of life frequently use benzodiazepines, despite concerns about risk for exacerbated confusion and limited high-quality evidence of effectiveness.

In a multicenter clinical trial in Taiwanese and U.S. palliative care units, researchers randomized 72 patients with advanced cancer and delirium who received haloperidol and who experienced breakthrough agit…