title: Dexmedetomidine for the Treatment of Hyperactive Delirium Refractory to Haloperidol in Nonintubated ICU Patients: A Nonrandomized Controlled Trial.
abstract: OBJECTIVE
  To evaluate the clinical effectiveness, safety, and cost of dexmedetomidine for the treatment of agitated delirium refractory to haloperidol in nonintubated critically ill patients.
  
  
  METHODS
  Nonrandomized, controlled trial.
  
  
  METHODS
  Intensive care department of a tertiary care nonprofit hospital.
  
  
  METHODS
  All consecutive admissions to a medical-surgical ICU with a diagnosis of agitated delirium.
  
  
  METHODS
  Initial haloperidol titration: all patients received IV bolus doses of haloperidol until agitation was controlled (Richmond Agitation Sedation Scale scoring range, 0 to -2) or reaching the maximum daily dose. Group comparison: patient responders to haloperidol (control group) were compared with nonresponders (dexmedetomidine group).
  
  
  RESULTS
  A total of 132 nonintubated patients were treated with haloperidol in the initial haloperidol titration phase. Forty-six patients (34.8%; 95% CI, 26.0-43.1%) did not respond to haloperidol, and 86 patients (65.2%; 95% CI, 56.3-73.0%) were responders. During the group comparison phase, dexmedetomidine achieved a higher percentage of time in satisfactory sedation levels than did haloperidol (92.7% [95% CI, 84.5-99.8%] vs 59.3% [95% CI, 48.6-69.3%], respectively; p = 0.0001). Haloperidol was associated with 10 cases (11.6% [95% CI, 6.5-21.2%]) of oversedation and two (2.0% [0.4-8%]) of corrected QT lengthening. Direct cost of dexmedetomidine was 17 times greater than haloperidol, but it achieved a mean savings of $4,370 per patient due to the reduction in length of ICU stay.
  
  
  CONCLUSIONS
  In the study conditions, dexmedetomidine shows to be useful as a rescue drug for treating agitation due to delirium in nonintubated patients in whom haloperidol has failed, and it seems to have a better effectiveness, safety, and cost-benefit profile than does haloperidol.
authors.affiliation: All authors: Department of Intensive Care Medicine, SCIAS Hospital de Barcelona, Barcelona, Spain.
authors.forename: Genís
authors.initials: G
authors.lastname: Carrasco
authors.forename: Nacho
authors.initials: N
authors.lastname: Baeza
authors.forename: Lluís
authors.initials: L
authors.lastname: Cabré
authors.forename: Eugenia
authors.initials: E
authors.lastname: Portillo
authors.forename: Gemma
authors.initials: G
authors.lastname: Gimeno
authors.forename: David
authors.initials: D
authors.lastname: Manzanedo
authors.forename: Milagros
authors.initials: M
authors.lastname: Calizaya
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003693:Delirium / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D004351:Drug Resistance; D005260:Female; D006220:Haloperidol / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000188:drug therapy; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D006220:Haloperidol