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

Collet M. O.

;Caballero J.;Sonneville R.;Bozza F. A.;Nydahl P.;Schandl A.;Woien H.;Citerio G.;van den Boogaard M.;Hastbacka J.;Haenggi M.;Colpaert K.;Rose L.;Barbateskovic M.;Lange T.;Jensen A.;Krog M. B.;Egerod I.;Nibro H. L.;Wetterslev J.;Perner A.;Agrifoglio A.;Patruno A.;Kalioubie A. E.;Lautrette A.;Miguel A.;Molinari A. F.;Toniolo A.;Rodt A. P.;Skafte A. A.;Nissen A. K.;Naharro A.;Berg A. M. N.;Estebanez;Garcia B.;Encina B.;Bundgaard B. S.;Rossen B. S.;Sjoeboe B. A.;Diaz C.;Backman C.;Leggieri C.;de Cabo C. M.;Pavo-Galan C.;Gutierrez C.;Tingsvik C.;Rousseau C.;Kjer C. K. W.;Almeida C.;Cantaroni C.;de Oliveira C. C.;Escudero;Pretorius D.;Hees D.;Manzanedo D.;Mamaev D.;Christensen D.;Skorstad E. M.;Lappi E.;Wiborg E.;Siven E.;Perecmanis E.;Sauter E.;De Lucas E. H.;Cabeza E. F.;Aakerman E.;Lovisari F.;Vagginelli F.;Nasstrom F.;Schioler F.;Moreno-Gonzalez G.;Martelli G.;Gimeno G.;Tanaskovic G.;Ramos G. V.;Abusdal G.;Aagaard G.;Jensen H. I.;Knudsen H.;Bundgaard H.;Hoffmeyer H.;Torrado H.;Aguirre-Bermeo H.;Perez-Molto H.;Jara;de Haas I.;Baerentsen I. D.;Finnstroem I. J.;Greve I. E.;Ceniceros I.;Savia I.;Astola I.;Elkjaer J. M. A.;Mira J. -P.;Palm J. L.;Soini J.;Olsson J. E.;Nyberg J.;Heinonen J.;Alonso J.;Garcia J. M. G.;Masclans J.;Goyeneche J. M.;Corral J. M.;Pilypaite J.;Bye K.;Saarinen K.;Wian K. -A.;Weber K.;Donadello K.;Kangas K.;Simons K. S.;Lundholm L.;Malchiodi L.;Alvarez L.;Han-Byul L.;Rabello L. S. C. F.;von Holck L.;Loisa P.;Buus L.;Christensen L. J.;Dall'ara L.;Melkersson L.;Orwelius L.;De Crop L.;Antoine M.;Santafe M.;Sanchez M.;Blackwell M. L.;Cronhjort M.;Martinez M.;Martin-Delgado M. C.;Levin M.;Maus M.;Henry-Lagarrigue M.;Romera M. A.;Valimaki M.;Bernal M. H.;Ramon N.;Baeza N.;Maquigneau N.;Marin N.;Moeller-Nielsen N.;Terzi N.;Glerup O.;Vinorum O.;Inkinen O.;Hild P.;Miquel-Diego P.;Rood P.;de Azambuja Rodrigues P. M.;Ernoe P. E.;Baadstoeloekken P. M.;Holm P.;Haltia P.;Ferrer R.;Hansen R.;Yano R.;Medici R.;da Silva R. T. A.;Smonig R.;Frederiksen R.;Sardo S.

Member of the Collaboration Group

;Sutinen S.;Kentala S.;Besset S.;Sant'Anna S. T.;Rodriguez S.;Zambelli S. E.;Contreras S.;Pedersen S.;Hufner S.;Leggio S.;Balsliemke S.;Gaudry S.;Estrup S.;Temprano S.;Nielsen S.;van Zuylen T.;Suhonen T.;Melms T.;Heinicke T.;Zinzoni V.;Blazquez-Alcaide V.;Jorgensen V. L.;Collado Z.

2018-01-01

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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.