Association of cumulative dose of haloperidol with next-day delirium in older medical ICU patients.
OBJECTIVE
To evaluate the association between cumulative dose of haloperidol and next-day diagnosis of delirium in a cohort of older medical ICU patients, with adjustment for its time-dependent confounding with fentanyl and intubation.


METHODS
Prospective, observational study.


METHODS
Medical ICU at an urban, academic medical center.


METHODS
Age 60 years and older admitted to the medical ICU who received at least one dose of haloperidol (n = 93). Of these, 72 patients were intubated at some point in their medical ICU stay, whereas 21 were never intubated.


METHODS
None.


RESULTS
Detailed data were collected concerning time, dosage, route of administration of all medications, as well as for important clinical covariates, and daily status of intubation and delirium using the confusion assessment method for the ICU and a chart-based algorithm. Among nonintubated patients, and after adjustment for time-dependent confounding and important covariates, each additional cumulative milligram of haloperidol was associated with 5% higher odds of next-day delirium with odds ratio of 1.05 (credible interval [CI], 1.02-1.09). After adjustment for time-dependent confounding and covariates, intubation was associated with a five-fold increase in odds of next-day delirium with odds ratio of 5.66 (CI, 2.70-12.02). Cumulative dose of haloperidol among intubated patients did not change their already high likelihood of next-day delirium. After adjustment for time-dependent confounding, the positive associations between indicators of intubation and of cognitive impairment and next-day delirium became stronger.


CONCLUSIONS
These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older medical ICU patients and demonstrate the value of assessing nonintubated patients.
1Department of Medicine, Pulmonary & Critical Care Section, and the Program on Aging, Yale University School of Medicine, New Haven, CT. 2Department of Medicine, Geriatrics Section, and the Program on Aging, Yale University School of Medicine, New Haven, CT.
Margaret A
MA
Pisani
Katy L B
KL
Araujo
Terrence E
TE
Murphy
D018806:APACHE; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications; D003693:Delirium / Q000139:chemically induced* / Q000150:complications; D004305:Dose-Response Relationship, Drug; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
D006220:Haloperidol