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Antipsychotics traditionally have been used to manage agitation in delirious patients at risk for injurious behavior. Recently, their use has expanded to include prophylaxis in patients at risk for delirium, as well as treating disorganized thinking in patients with hypoactive symptoms. Two 2018 studies should halt any enthusiasm for this trend.
The REDUCE trial involved 1800 intensive care unit (ICU) patients in the Netherlands who were at risk for delirium. Patients were randomized to receive haloperidol (1 mg or 2 mg thrice daily) or placebo. The 1-mg haloperidol arm was stopped early due to futility. Mortality at 28 days and 90 days did not differ between the 2-mg haloperidol and placebo groups. Incidence of delirium (33%), duration of I…