Haloperidol Doesn't Prevent Delirium in Critically Ill Patients

Delirium, a common complication of critical illness, is associated with longer duration of hospital stay and excess risk for death. Many intensive care units (ICUs) have implemented nonpharmacologic strategies to lower risk for delirium (e.g., early mobility, noise reduction, improved sleep hygiene). To date, no pharmacologic interventions have been proven to prevent delirium. Despite limited evidence of efficacy, haloperidol often is used to treat patients with delirium, and retrospective studies have suggested this agent also might help prevent the condition.

Investigators in the Netherlands randomized 1789 ICU patients at risk for delirium (based only on attending physicians' judgment that ICU stay would be ≥2 days) to receive intravenous haloperidol (1 mg or 2 mg, thrice daily) or placebo. The 1-mg arm was stopped early for futility; the 2-mg and placebo groups were compared. Mortality at both 28 and 90 days did not differ between the haloperidol and placebo groups. Incidence of delirium (33%), duration of ICU and hospital stays, and duration of mechanical ventilation also were unaffected by treatment.