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2020-07-11
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PREVALENCE AND RISK FACTORS RELATED TO HALOPERIDOL USE FOR DELIRIUM IN ADULT INTENSIVE CARE PATIENTS: THE MULTINATIONAL AID-ICU INCEPTION COHORT STUDY
Author
Collet, Marie O.
Caballero, Jesús
Sonneville, Romain
Bozza, Fernando A.
Nydahl, Peter
Schandl, Anna
Wøien, Hilden
Citerio, Giuseppe
Boogaard, Mark van den
Hästbacka, Johanna
Haenggi, Matthias
Colpaert, Kirsten
Rose, Louise
Barbateskovic, Marija
Lange, Theis
Jensen, Aksel
Krog, Martin B.
Egerod, Ingrid
Nibro, Helle L.
Wetterslev, Jørn
Perner, Anders
Caballero, Jesús
Sonneville, Romain
Bozza, Fernando A.
Nydahl, Peter
Schandl, Anna
Wøien, Hilden
Citerio, Giuseppe
Boogaard, Mark van den
Hästbacka, Johanna
Haenggi, Matthias
Colpaert, Kirsten
Rose, Louise
Barbateskovic, Marija
Lange, Theis
Jensen, Aksel
Krog, Martin B.
Egerod, Ingrid
Nibro, Helle L.
Wetterslev, Jørn
Perner, Anders
Affilliation
Copenhagen University Hospital. Rigshospitalet. Department of Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Hospital Universitari Arnau de Vilanova. IRB Lleida. Lleida, Spain / Hospital Universitari Vall d’Hebron. Barcelona, Spain / Universitat Autònoma de Barcelona. Barcelona, Spain.
Assistance publique–Hôpitaux de Paris. Bichat Claude Bernard Hospital. Department of Intensive Care Medicine and Infectious Diseases. Paris, France / Sorbonne Paris Cité. Inserm. UMR1148, LVTS. Paris, France / Paris Diderot University, Paris, France.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
University Hospital of Schleswig-Holstein. Department of Nursing Research. Kiel, Germany / University Hospital of Schleswig-Holstein. Department of Anaesthesiology and Intensive Care Medicine. Kiel, Germany.
Karolinska University Hospital. Department of Perioperative Medicine and Intensive Care. Stockholm, Sweden.
Oslo University Hospital. Division of Emergencies and Intensive Care. Oslo, Norway.
University of Milano Bicocca. School of Medicine and Surgery. Neuroanaesthesia and Neurointensive Care. Milan, Italy / H. San Gerardo Monza, Italy.
Radboud University Medical Center. Department Intensive Care Medicine. Nijmegen, The Netherlands.
University of Helsinki. Helsinki University Hospital. Department of Anaesthesia, Intensive Care and Pain Medicine. Division of Intensive Care. Helsinki, Finland.
University of Bern. University Hospital Bern. Department of Intensive Care Medicine. Bern, Switzerland.
University Hospital Gent. Intensive Care Unit. Ghent, Belgium.
Sunnybrook Health Sciences Centre. Department of Critical Care Medicine. Toronto, ON, Canada / King’s College London. Florence Nightingale Faculty of Nursing, Midwife and Palliative Care. London, UK.
Centre for Research in Intensive Care. Copenhagen, Denmark / Copenhagen University Hospital. Rigshospitalet. Copenhagen Trial Unit. Copenhagen, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / University of Copenhagen. Department of Public Health. Section of Biostatistics. Copenhagen, Denmark / Peking University.
Centre for Research in Intensive Care. Copenhagen, Denmark / University of Copenhagen. Department of Public Health. Section of Biostatistics. Copenhagen, Denmark. Centre for Statistical Science. Beijing, China.
University Hospital Aarhus. Department of Intensive Care. Aarhus, Denmark.
Copenhagen University Hospital. Rigshospitalet. Department of Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / University Hospital Aarhus. Department of Intensive Care. Aarhus, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Copenhagen University Hospital. Rigshospitalet. Department of Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Hospital Universitari Arnau de Vilanova. IRB Lleida. Lleida, Spain / Hospital Universitari Vall d’Hebron. Barcelona, Spain / Universitat Autònoma de Barcelona. Barcelona, Spain.
Assistance publique–Hôpitaux de Paris. Bichat Claude Bernard Hospital. Department of Intensive Care Medicine and Infectious Diseases. Paris, France / Sorbonne Paris Cité. Inserm. UMR1148, LVTS. Paris, France / Paris Diderot University, Paris, France.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
University Hospital of Schleswig-Holstein. Department of Nursing Research. Kiel, Germany / University Hospital of Schleswig-Holstein. Department of Anaesthesiology and Intensive Care Medicine. Kiel, Germany.
Karolinska University Hospital. Department of Perioperative Medicine and Intensive Care. Stockholm, Sweden.
Oslo University Hospital. Division of Emergencies and Intensive Care. Oslo, Norway.
University of Milano Bicocca. School of Medicine and Surgery. Neuroanaesthesia and Neurointensive Care. Milan, Italy / H. San Gerardo Monza, Italy.
Radboud University Medical Center. Department Intensive Care Medicine. Nijmegen, The Netherlands.
University of Helsinki. Helsinki University Hospital. Department of Anaesthesia, Intensive Care and Pain Medicine. Division of Intensive Care. Helsinki, Finland.
University of Bern. University Hospital Bern. Department of Intensive Care Medicine. Bern, Switzerland.
University Hospital Gent. Intensive Care Unit. Ghent, Belgium.
Sunnybrook Health Sciences Centre. Department of Critical Care Medicine. Toronto, ON, Canada / King’s College London. Florence Nightingale Faculty of Nursing, Midwife and Palliative Care. London, UK.
Centre for Research in Intensive Care. Copenhagen, Denmark / Copenhagen University Hospital. Rigshospitalet. Copenhagen Trial Unit. Copenhagen, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / University of Copenhagen. Department of Public Health. Section of Biostatistics. Copenhagen, Denmark / Peking University.
Centre for Research in Intensive Care. Copenhagen, Denmark / University of Copenhagen. Department of Public Health. Section of Biostatistics. Copenhagen, Denmark. Centre for Statistical Science. Beijing, China.
University Hospital Aarhus. Department of Intensive Care. Aarhus, Denmark.
Copenhagen University Hospital. Rigshospitalet. Department of Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / University Hospital Aarhus. Department of Intensive Care. Aarhus, Denmark.
Centre for Research in Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
Copenhagen University Hospital. Rigshospitalet. Department of Intensive Care. Copenhagen, Denmark / Centre for Research in Intensive Care. Copenhagen, Denmark.
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 72h 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 frst 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 signifcantly associated with increased 90-day mortality.
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