Haloperidol for the treatment of delirium in critically ill patients: an updated systematic review with meta-analysis and trial sequential analysis

Critical Care

Research

Marie Oxenbøll Collet¹  Anders Perner²  Jørn Wetterslev³  Marija Barbateskovic⁴  Mathias Maagaard⁵  Nina Christine Andersen-Ranberg⁶  Lone Musaeus Poulsen⁶  Ole Mathiesen⁷  Mathieu van der Jagt⁸  Lisa Smit⁸ 

[1] Collaboration for Research in Intensive Care (CRIC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Collaboration for Research in Intensive Care (CRIC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark;Collaboration for Research in Intensive Care (CRIC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Private Office, Tuborg Sundpark 3, 1. Th., 2900, Hellerup, Copenhagen, Denmark;Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark;Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark;Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark;Collaboration for Research in Intensive Care (CRIC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark;Collaboration for Research in Intensive Care (CRIC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark;Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark;Department of Intensive Care, Erasmus MC – University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands;

关键词: Delirium;    Haloperidol;    Antipsychotics;    Systematic review;    Meta-analysis;   

DOI  :  10.1186/s13054-023-04621-4

 received in 2023-07-09, accepted in 2023-08-19,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundHaloperidol is frequently used in critically ill patients with delirium, but evidence for its effects has been sparse and inconclusive. By including recent trials, we updated a systematic review assessing effects of haloperidol on mortality and serious adverse events in critically ill patients with delirium.MethodsThis is an updated systematic review with meta-analysis and trial sequential analysis of randomised clinical trials investigating haloperidol versus placebo or any comparator in critically ill patients with delirium. We adhered to the Cochrane handbook, the PRISMA guidelines and the grading of recommendations assessment, development and evaluation statements. The primary outcomes were all-cause mortality and proportion of patients with one or more serious adverse events or reactions (SAEs/SARs). Secondary outcomes were days alive without delirium or coma, delirium severity, cognitive function and health-related quality of life.ResultsWe included 11 RCTs with 15 comparisons (n = 2200); five were placebo-controlled. The relative risk for mortality with haloperidol versus placebo was 0.89; 96.7% CI 0.77 to 1.03; I2 = 0% (moderate-certainty evidence) and for proportion of patients experiencing SAEs/SARs 0.94; 96.7% CI 0.81 to 1.10; I2 = 18% (low-certainty evidence). We found no difference in days alive without delirium or coma (moderate-certainty evidence). We found sparse data for other secondary outcomes and other comparators than placebo.ConclusionsHaloperidol may reduce mortality and likely result in little to no change in the occurrence of SAEs/SARs compared with placebo in critically ill patients with delirium. However, the results were not statistically significant and more trial data are needed to provide higher certainty for the effects of haloperidol in these patients.Trial registration: CRD42017081133, date of registration 28 November 2017.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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