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Title: Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial.
Austin Authors: Reade, Michael C;O'Sullivan, Kim;Bates, Samantha;Goldsmith, Donna;Ainslie, William R S T J;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care Medicine, Austin Hospital and the University of Melbourne, 145 Studley Road, Heidelberg, Victoria 3084, Australia
Issue Date: 19-May-2009
Publication information: Critical Care 2009; 13(3): R75
Abstract: Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation.We conducted a randomised, open-label, parallel-groups pilot trial in the medical and surgical intensive care unit of a university hospital. Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were randomised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 microg/kg/hr, with or without loading doses of 2.5 mg haloperidol or 1 mug/kg dexmedetomidine, according to clinician preference.Dexmedetomidine significantly shortened median time to extubation from 42.5 (IQR 23.2 to 117.8) to 19.9 (IQR 7.3 to 24) hours (P = 0.016). Dexmedetomidine significantly decreased ICU length of stay, from 6.5 (IQR 4 to 9) to 1.5 (IQR 1 to 3) days (P = 0.004) after study drug commencement. Of patients who required ongoing propofol sedation, the proportion of time propofol was required was halved in those who received dexmedetomidine (79.5% (95% CI 61.8 to 97.2%) vs. 41.2% (95% CI 0 to 88.1%) of the time intubated; P = 0.05). No patients were reintubated; three receiving haloperidol could not be successfully extubated and underwent tracheostomy. One patient prematurely discontinued haloperidol due to QTc interval prolongation.In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre NCT00505804.
Gov't Doc #: 19454032
DOI: 10.1186/cc7890
Journal: Critical Care
Type: Journal Article
Subjects: Adult
Delirium.drug therapy.etiology
Dexmedetomidine.adverse effects.therapeutic use
Dopamine Antagonists.adverse effects.therapeutic use
Drug-Related Side Effects and Adverse Reactions
Haloperidol.adverse effects.therapeutic use
Hypnotics and Sedatives.adverse effects.therapeutic use
Intubation, Intratracheal
Middle Aged
Pilot Projects
Psychomotor Agitation.drug therapy.etiology
Respiration, Artificial
Appears in Collections:Journal articles

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