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Intensive Care Medicine

, Volume 44, Issue 7, pp 1081–1089 | Cite as

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

  • Marie O. Collet
  • Jesús Caballero
  • Romain Sonneville
  • Fernando A. Bozza
  • Peter Nydahl
  • Anna Schandl
  • Hilden Wøien
  • Giuseppe Citerio
  • Mark van den Boogaard
  • Johanna Hästbacka
  • Matthias Haenggi
  • Kirsten Colpaert
  • Louise Rose
  • Marija Barbateskovic
  • Theis Lange
  • Aksel Jensen
  • Martin B. Krog
  • Ingrid Egerod
  • Helle L. Nibro
  • Jørn Wetterslev
  • Anders Perner
  • the AID-ICU cohort study co-authors
Original

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.

Keywords

Delirium ICU Haloperidol Cohort Critical care 

Notes

Acknowledgements

The AID-ICU cohort study investigators are listed in the ESM.

Funding information

The AID-ICU study is funded by the Innovation Foundation Denmark.

Compliance with ethical standards

Conflicts of Interest

The ICU at Rigshospitalet has received support for research from Fresenius Kabi, CSL Behring and Ferring Pharmaceuticals. The ICU at Bern University Hospital has received support from Orion Corporation, Abbott Nutrition International, B. Braun Medical AG, CSEM SA, Edwards Lifesciences Services GmbH/SA, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical research AG and Nestlé. Same ICU department received educational grants from Fresenius Kabi, GSK, MSD, Lilly, Baxter, Astellas, AstraZeneca, B. Braun Medical AG, CSL Behring, Maquet, Novartis, Covidien, Nycomed, Pierre Fabre Pharma (Robe Pharma), Pfizer, and Orion Pharma. Author Jesus Caballero has received funds from Astellas, Medtronic, Sedana Medical, Orion Pharma, Pfizer and Brinda Healthcare.

Supplementary material

134_2018_5204_MOESM1_ESM.docx (195 kb)
Supplementary material 1 (DOCX 195 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Marie O. Collet
    • 1
    • 2
  • Jesús Caballero
    • 3
  • Romain Sonneville
    • 4
    • 5
  • Fernando A. Bozza
    • 6
  • Peter Nydahl
    • 7
    • 8
  • Anna Schandl
    • 9
  • Hilden Wøien
    • 10
  • Giuseppe Citerio
    • 11
  • Mark van den Boogaard
    • 12
  • Johanna Hästbacka
    • 13
  • Matthias Haenggi
    • 14
  • Kirsten Colpaert
    • 15
  • Louise Rose
    • 16
    • 17
  • Marija Barbateskovic
    • 2
    • 18
  • Theis Lange
    • 2
    • 19
    • 21
  • Aksel Jensen
    • 2
    • 19
  • Martin B. Krog
    • 20
  • Ingrid Egerod
    • 1
    • 2
  • Helle L. Nibro
    • 2
    • 20
  • Jørn Wetterslev
    • 2
    • 18
  • Anders Perner
    • 1
    • 2
  • the AID-ICU cohort study co-authors
  1. 1.Department of Intensive CareCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
  2. 2.Centre for Research in Intensive CareCopenhagenDenmark
  3. 3.Hospital Universitari Arnau de Vilanova de Lleida-IRBLleida, Hospital Universitari Vall d’Hebron-VHIR, Universitat Autònoma de Barcelona-UABBarcelonaSpain
  4. 4.Department of Intensive Care Medicine and Infectious DiseasesBichat Claude Bernard Hospital, AP-HPParisFrance
  5. 5.UMR1148, LVTSSorbonne Paris Cité, Inserm/Paris Diderot UniversityParisFrance
  6. 6.National Institute of Infectious Disease, Oswaldo Cruz Foundation, Ministry of HealthRio de JaneiroBrazil
  7. 7.Department of Nursing ResearchUniversity Hospital of Schleswig-HolsteinKielGermany
  8. 8.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital of Schleswig-HolsteinKielGermany
  9. 9.Department of Perioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden
  10. 10.Division of Emergencies and Intensive CareOslo University HospitalOsloNorway
  11. 11.Neuroanaesthesia and Neurointensive Care, School of Medicine and SurgeryH San Gerardo Monza, University of Milano BicoccaMilanItaly
  12. 12.Department Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
  13. 13.Division of Intensive Care, Department of Anaesthesia, Intensive Care and Pain MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
  14. 14.Department of Intensive Care MedicineUniversity Hospital Bern, Inselspital, University of BernBernSwitzerland
  15. 15.Intensive Care UnitUniversity Hospital GentGhentBelgium
  16. 16.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada
  17. 17.Florence Nightingale Faculty of Nursing, Midwife and Palliative CareKing’s College LondonLondonUK
  18. 18.Copenhagen Trial UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
  19. 19.Department of Public Health, Section of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
  20. 20.Department of Intensive CareUniversity Hospital AarhusAarhusDenmark
  21. 21.Centre for Statistical SciencePeking UniversityBeijingChina

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