Type of We recommend against offering this We suggest not offering this We suggest offering this We recommend offering this recommendation option option option option ○ ● ○ ○ We do not suggest using haloperidol for sub-syndromal delirium in critically ill patients as there is little evidence that it decreases Recommendation incidence of full syndrome delirium, ICU length of stay, days of mechanical ventilation, delirium duration, or mortality. Justification We are moderately certain that haloperidol use is not associated with decreased duration of delirium or ICU length of stay. We have low certainty about the effect of haloperidol on mortality. Given the lack of clear benefit patients should not be routinely exposed to potential harms associated with this medication. Patients who experience significant distress secondary to symptoms of a delirium such as anxiety, fearfulness, hallucinations, Subgroup considerations or delusions or who may be physically threatening to self or others may benefit from the use of lowest effective of haloperidol for symptomatic relief. Haloperidol should be discontinued following the resolution of the patient's distress. Research More research is needed on the benefit of haloperidol in treating distress due to delirium symptoms and system innovations to ensure possibilities that patients do not remain on antipsychotics indefinitely following symptomatic initiation during a delirium episode. Can we say haloperidol should never be used in sub-syndromal delirium? What if pt. is subsyndromal & agitated, belligerent, etc. Comments during electronic voting by without enteral access? entire panel Author(s): Mark E. Nunnally Question: An atypical antipsychotic compared to no such strategy in critically ill adults WITH subsyndromal delirium Setting: intensive Care Units Bibliography: Hakim 2012 Quality assessment of patients Effect № Quality Importance of Study an atypical Relative Absolute № Risk of bias Inconsistency Indirectness Imprecision Other considerations no such strategy studies design antipsychotic (95% CI) (95% CI) discharge to a nursing home
Type of recommendation We recommend against offering this option We suggest not offering this option We suggest offering this option We recommend offering this option ○ ● ○ ○ Recommendation We do not suggest using haloperidol for sub-syndromal delirium in critically ill patients as there is little evidence that it decreases incidence of full syndrome delirium, ICU length of stay, days of mechanical ventilation, delirium duration, or mortality. Justification We are moderately certain that haloperidol use is not associated with decreased duration of delirium or ICU length of stay. We have low certainty about the effect of haloperidol on mortality. Given the lack of clear benefit patients should not be routinely exposed to potential harms associated with this medication. Subgroup considerations Patients who experience significant distress secondary to symptoms of a delirium such as anxiety, fearfulness, hallucinations, or delusions or who may be physically threatening to self or others may benefit from the use of lowest effective of haloperidol for symptomatic relief. Haloperidol should be discontinued following the resolution of the patient's distress. Research possibilities More research is needed on the benefit of haloperidol in treating distress due to delirium symptoms and system innovations to ensure that patients do not remain on antipsychotics indefinitely following symptomatic initiation during a delirium episode. Comments during electronic voting by entire panel Can we say haloperidol should never be used in sub-syndromal delirium? What if pt. is subsyndromal & agitated, belligerent, etc. without enteral access? Author(s): Mark E. Nunnally Question: An atypical antipsychotic compared to no such strategy in critically ill adults WITH subsyndromal delirium Setting: intensive Care Units Bibliography: Hakim 2012 Quality assessment № of patients Effect Quality Importance № of studies Study design Risk of bias Inconsistency Indirectness Imprecision Other considerations an atypical antipsychotic no such strategy Relative (95% CI) Absolute (95% CI) discharge to a nursing home
CCM_46_9_2018_06_08_DEVLIN_CCMED-D-18-00069_SDC26.docx