(973) Haloperidol for Delirium in Intensive Care Unit Patients: A Systematic Review and Meta-Analysis

Introduction: Delirium is a common complication in intensive care unit (ICU) patients, and haloperidol is an antipsychotic routinely used in this context despite of the lack of recommendation in current guidelines. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing haloperidol versus placebo for the treatment of delirium in ICU patients.

Methods: We systematically searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing the use of haloperidol with placebo for the treatment of delirium in ICU patients. We followed Cochrane and PRISMA recommendations. Random-effects model were used for all outcomes. We used R software version 4.3.1 for all statistical analyses. Heterogeneity was examined with I2 statistics. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the certainty of evidence of the primary outcome.

Results: We included four RCTs with a total of 1,464 patients, of whom 743 were assigned to the haloperidol group. Compared to placebo, haloperidol significantly increased the number of days without delirium or coma were significantly lower (SMD 0.12; 95% CI 0.01 to 0.22; p=0.03; I2=0%; high certainty of evidence) and reduced the time to ICU (MD -1.07 days; 95% CI -1.85 to -0.28; p< 0.01; I²=0%). However, there was no significant difference between groups in terms of short- (RR 0.86; 95% CI 0.73 to 1.01; p=0.07; I2=0%;) and long-term mortality (RR 0.93; 95% CI 0.74 to 1.18; p=0.55; I2=36%) and length of hospital stay (MD 0.58 days; 95% CI -3.01 to 1.86; p=0.64; I2=62%). Adverse events such as extrapyramidal symptoms and QTc prolongation were not statistically significant different between groups.

Conclusions: In patients with delirium in ICU, haloperidol significantly reduced days with delirium or coma and time to ICU discharge, without increasing adverse events. Our results suggest that haloperidol could be considered for patients in ICU.