Haloperidol for delirium? Moving on

The article by Paton and others, ‘Utility of the PRE-DELIRIC delirium prediction model in a Scottish ICU cohort' was a good illustrative piece of work with regard to delirium in critically ill patients. ¹ I would, however, challenge the concept that haloperidol shows any promise in preventing ICU delirium. There is quality evidence available demonstrating that haloperidol does not prevent or treat delirium. The UK Hope-ICU trial, early administration of haloperidol vs placebo to prevent/treat delirium, showed no patient benefit with regard to delirium, Al-Qadheeb and others in Boston showed it did not prevent delirium and most recently in an Australian study, presented at the European Delirium Association congress, palliative care patients who received haloperidol or risperidone as opposed to placebo had more delirium symptoms, and required more rescue midazolam.^2,3

I anticipate the ongoing trials into haloperidol for the prevention or treatment of ICU delirium will all show the same result and wish that clinicians would restrict the use of haloperidol to the acute management of agitation due to delirium, implement non-pharmacological measures and explore therapeutic interventions that do not include antipsychotics. Let’s move on.