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Abstract

Introduction: SCCM guidelines suggest haloperidol as the agent of choice for delirium management, yet the optimal dosing regimen is not well defined. Within our SICUs, two prescriber-dependent dosing strategies have emerged; a “conservative” strategy utilizing doses of 2mg or less given as a scheduled regimen and a “traditional” strategy utilizing larger doses above 2mg given as needed. Hypothesis: A difference in resolution of delirium and patient outcomes will be observed. Methods: This retrospective review included SICU patients that received at least one dose of haloperidol. Primary outcome measures: time to resolution of delirium, length of treatment, median dose per day of haloperidol and adjunctive treatment (hydromorphone or lorazepam equivalents), length of ICU and hospital stay. Secondary outcomes: delirium recognition, over-sedation and QTc prolongation. Data collected: demographics, APACHE II score, drug regimens, CAM score, treatment outcomes, length of stay, SAS score and QTc. Results: The study included 164 patients, with 82% in the conservative strategy group. There were an equal number of men and women, a mean age of 78 years and 69 in the conservative and traditional groups, respectively, and median APACHE II scores of 16 and 14. Time to delirium resolution was not different (5d v. 7, p=0.2). The conservative group received a longer duration of haloperidol treatment (3d v. 2, p=0.2) and less haloperidol per day (1.3mg v. 6.3, p <0.01). More opioids (2.3mg v 1.6, p=0.7) and benzodiazepines (1.2mg v. 1, p=0.5) were given to those in the traditional group, while more patients in the conservative group received adjunctive anti-psychotics (28% v. 19%, p=0.6). More patients in the traditional group had positive CAM scores at haloperidol initiation versus the conservative group (63% v. 57%, p=0.9). Hospital and SICU LOS, adjunctive treatment, over-sedation and QTc prolongation were not impacted by dosing strategy. Conclusions: The dosing strategy did not significantly impact time to resolution of delirium, delirium treatment length, adjunctive treatment, length of SICU or hospital stay, delirium recognition, over-sedation or QTc prolongation.