Zhen Chen1, Rui Chen2, Donghua Zheng3, Yongpeng Su1, Shuchao Wen1, Huocheng Guo1, Zhigang Ye1, Yingxin Deng4, Genglong Liu5, Liuer Zuo6, Xuxia Wei7, Yunqi Hou8. 1. Department of Intensive Care Unit, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan 528308, Guangdong Province, PR China. 2. Department of Medical Intensive Care Unit, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, Guangdong Province, PR China. 3. Department of Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, PR China. 4. Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan 528308, Guangdong Province, PR China. 5. Department of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, Guangdong Province, PR China. Electronic address: lglong3@mail2.sysu.edu.cn. 6. Department of Intensive Care Unit, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan 528308, Guangdong Province, PR China. Electronic address: 13500276597@163.com. 7. Department of Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, PR China. Electronic address: weixuxia06@163.com. 8. Department of Neurology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan 528308, Guangdong Province, PR China. Electronic address: drhouyunqi@163.com.
Abstract
STUDY OBJECTIVE: To identify the efficacy and safety of haloperidol prophylaxis in adult patients with a high risk for delirium. DESIGN: A meta-analysis with trial sequential analysis of randomized controlled trials. INTERVENTION: A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to March 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence. MAIN RESULTS: We appraised 8 RCTs involving 3034 patients that that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving haloperidol prophylaxis and placebo or normal saline did not significantly differ in incidence of delirium (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.70 to 1.15), with TSA inconclusive. Notably, compared with the control group, use of haloperidol significantly decreased the duration of delirium (Mean difference [MD] -0.94; 95% CI -1.82 to -0.06 days), with a marked heterogeneity. Additionally, haloperidol prophylaxis does not significantly affect duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality. In terms of safety profiles, haloperidol was not associated with increased risk for QTc prolongation, extrapyramidal symptoms, or adverse events. GRADE indicated the level of evidence was very low for a benefit from haloperidol prophylaxis. CONCLUSIONS: The results of our meta-analysis suggested the use of prophylactic haloperidol compared with placebo had no beneficial impacts on incidence of delirium, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality in adult patients. It appeared to have a positive effect on duration of delirium, while with a significant heterogeneity. These findings do not support the routine usage of haloperidol for delirium prevention. TRIAL REGISTRATION: PROSPERO registration number: CRD42018100511. Registered on 17 July 2018.
STUDY OBJECTIVE: To identify the efficacy and safety of haloperidol prophylaxis in adult patients with a high risk for delirium. DESIGN: A meta-analysis with trial sequential analysis of randomized controlled trials. INTERVENTION: A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to March 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence. MAIN RESULTS: We appraised 8 RCTs involving 3034 patients that that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving haloperidol prophylaxis and placebo or normal saline did not significantly differ in incidence of delirium (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.70 to 1.15), with TSA inconclusive. Notably, compared with the control group, use of haloperidol significantly decreased the duration of delirium (Mean difference [MD] -0.94; 95% CI -1.82 to -0.06 days), with a marked heterogeneity. Additionally, haloperidol prophylaxis does not significantly affect duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality. In terms of safety profiles, haloperidol was not associated with increased risk for QTc prolongation, extrapyramidal symptoms, or adverse events. GRADE indicated the level of evidence was very low for a benefit from haloperidol prophylaxis. CONCLUSIONS: The results of our meta-analysis suggested the use of prophylactic haloperidol compared with placebo had no beneficial impacts on incidence of delirium, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality in adult patients. It appeared to have a positive effect on duration of delirium, while with a significant heterogeneity. These findings do not support the routine usage of haloperidol for delirium prevention. TRIAL REGISTRATION: PROSPERO registration number: CRD42018100511. Registered on 17 July 2018.
Authors: Chung Kwan Wong; Barbara C van Munster; Athanasios Hatseras; Else Huis In 't Veld; Barbara L van Leeuwen; Sophia E de Rooij; Rick G Pleijhuis Journal: BMJ Open Date: 2022-04-08 Impact factor: 2.692
Authors: Sangil Lee; Hao Chen; Seikei Hibino; Daniel Miller; Heather Healy; Jacques S Lee; Glenn Arendts; Jin Ho Han; Maura Kennedy; Christopher R Carpenter Journal: J Am Geriatr Soc Date: 2022-03-11 Impact factor: 7.538