TY - JOUR
T1 - Haloperidol for the treatment of delirium in critically ill patients
T2 - an updated systematic review with meta-analysis and trial sequential analysis
AU - Andersen-Ranberg, Nina Christine
AU - Barbateskovic, Marija
AU - Perner, Anders
AU - Oxenbøll Collet, Marie
AU - Musaeus Poulsen, Lone
AU - van der Jagt, Mathieu
AU - Smit, Lisa
AU - Wetterslev, Jørn
AU - Mathiesen, Ole
AU - Maagaard, Mathias
N1 - © 2023. BioMed Central Ltd., part of Springer Nature.
PY - 2023/8/26
Y1 - 2023/8/26
N2 - BACKGROUND: Haloperidol 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.METHODS: This 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.RESULTS: We 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.CONCLUSIONS: Haloperidol 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.
AB - BACKGROUND: Haloperidol 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.METHODS: This 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.RESULTS: We 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.CONCLUSIONS: Haloperidol 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.
KW - Humans
KW - Haloperidol/therapeutic use
KW - Coma
KW - Critical Illness/therapy
KW - Quality of Life
KW - Delirium/drug therapy
KW - Randomized Controlled Trials as Topic
U2 - 10.1186/s13054-023-04621-4
DO - 10.1186/s13054-023-04621-4
M3 - Review
C2 - 37633991
SN - 1364-8535
VL - 27
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 329
ER -