Introduction: Acutely agitated patients presenting to the emergency department (ED) often demonstrate dangerous behavior that can result in injury to themselves and staff. The combination of an antipsychotic and a benzodiazepine is frequently used for emergent sedation; however, this combination is associated with common adverse effects such as airway compromise, hypotension, and delirium. Droperidol use for emergent sedation has increased due to its rapid onset and short duration of action. The purpose of this study was to evaluate the safety and efficacy of droperidol as monotherapy and combination for agitated patients in the ED.
Methods: This is a retrospective chart review that included adult patients who received at least one dose of droperidol for acute agitation in the ED. Patients were excluded if droperidol was administered for non-agitation indications. The primary outcome was the proportion of patients needing rescue sedatives after the initial droperidol dose. Secondary outcomes included the proportion of patients that received droperidol alone or in combination and safety adverse effects such as QTc prolongation, need for vasopressors, and respiratory depression. This study was exempt from IRB approval.
Results: Of the 226 patients that received droperidol in the ED, 158 were included in this review. There were 97 (61%) patients that received monotherapy while 61 patients (39%) patients received combination therapy. Of these patients, 16% of patients in the monotherapy group received rescue sedatives compared to 15% in the combination therapy group. Safety adverse effects occurred more frequently in the combination versus monotherapy group (7% vs 5%). This included 4 patients in both groups with respiratory depression and 1 patient with QTc prolongation in the combination therapy group.
Conclusions: Droperidol was often utilized as monotherapy in acutely agitated patients presenting to the ED. In this study, combination therapy compared to monotherapy was not more efficacious in adequately controlling agitation. Additionally, using droperidol in combination with benzodiazepines may result in increased adverse effects. The use of droperidol may be beneficial for sedation of acutely agitated patients in the ED and requires additional monitoring.
