Haloperidol does not prevent delirium in ICU patients

The study has demonstrated that in critically ill patients currently receiving best-practice nonpharmacological interventions to prevent delirium, the addition of haloperidol does not improve survival nor reduce the incidence of delirium or the harms associated with delirium. The findings challenge the current model that the addition of psychoactive medication to patients who are already receiving multiple interventions may be beneficial. Prophylactic haloperidol is not the solution for the complex problem of delirium in critically ill patients. It may be that no single pharmacological intervention can provide a solution.

Future research is warranted into nonpharmacological interventions. They generally involve either doing less for patients (avoiding excessive sedation, benzodiazepines, nocturnal noise, and stimulation) or ensuring the continued provision of relatively simple therapies (mobilization, maintaining a day-night schedule, and noise reduction). Although some of these interventions may require planning and cooperation of a multidisciplinary team, a strength of ICU care in general, other interventions may be as simple as providing earplugs and eye patches to improve sleep.

Anthony Delaney, MD, PhD, is associate professor of intensive care medicine at the University of Sydney. Naomi Hammond, PhD, is a research fellow and senior lecturer at the University of New South Wales, Sydney. Edward Litton, MD, PhD, is an intensive care specialist in Perth, Australia. They made their comments in a JAMA editorial, and had no disclosures ( JAMA. 2018 Feb 20;319[7]:659-60 ).