title: Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium: a prospective cohort study.
abstract: OBJECTIVE
  Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could be increased. Length of stay (LOS), complications and 180-day mortality are reported.
  
  
  METHODS
  Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression.
  
  
  RESULTS
  Incidence of delirium after cardiac surgery was 21 (14-29) and 22 (15-30) %, onset was on postoperative day 1 (1-4) and 1 (1-3), duration was 1 (1-4) day and 3 (1-5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61-73) and 65 (60-70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and complications.
  
  
  CONCLUSIONS
  We observed no increase in the proportion of delirium- and coma-free days after introduction of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium. Most patients were not severely affected, and the few who were, proved difficult to treat, indicating that a simple treatment protocol with haloperidol was ineffective.
authors.affiliation: Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Sofie
authors.initials: S
authors.lastname: Schrøder Pedersen
authors.forename: Thomas
authors.initials: T
authors.lastname: Kirkegaard
authors.forename: Martin
authors.initials: M
authors.lastname: Balslev Jørgensen
authors.forename: Vibeke
authors.initials: V
authors.lastname: Lind Jørgensen
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D057189:Checklist; D016009:Chi-Square Distribution; D003693:Delirium / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D003718:Denmark; D042241:Early Diagnosis; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol
keywords: Cardiac surgery; Complications; Delirium; Post-cardiotomy; Postoperative care; Postoperative cognitive dysfunction