Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial

Reade, Michael C., O'Sullivan, Kim, Bates, Samantha, Goldsmith, Donna, Ainslie, William R. S. T. J. and Bellomo, Rinaldo (2009) Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Critical Care, 13 . doi:10.1186/cc7890

Author Reade, Michael C.
O'Sullivan, Kim
Bates, Samantha
Goldsmith, Donna
Ainslie, William R. S. T. J.
Bellomo, Rinaldo
Title Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
Publication date 2009-05-19
Sub-type Article (original research)
DOI 10.1186/cc7890
Open Access Status DOI
Volume 13
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Formatted abstract
Introduction: Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation.

Methods: We conducted a randomised, open-label, parallel-groups pilot trial in the medical and surgical intensive care unit of a university hospital. Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were randomised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 μg/kg/hr, with or without loading doses of 2.5 mg haloperidol or 1 μg/kg dexmedetomidine, according to clinician preference.

Results: Dexmedetomidine significantly shortened median time to extubation from 42.5 (IQR 23.2 to 117.8) to 19.9 (IQR 7.3 to 24) hours (P = 0.016). Dexmedetomidine significantly decreased ICU length of stay, from 6.5 (IQR 4 to 9) to 1.5 (IQR 1 to 3) days (P = 0.004) after study drug commencement. Of patients who required ongoing propofol sedation, the proportion of time propofol was required was halved in those who received dexmedetomidine (79.5% (95% CI 61.8 to 97.2%) vs. 41.2% (95% CI 0 to 88.1%) of the time intubated; P = 0.05). No patients were reintubated; three receiving haloperidol could not be successfully extubated and underwent tracheostomy. One patient prematurely discontinued haloperidol due to QTc interval prolongation.

Conclusions: In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial.
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Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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