Haloperidol vs Olanzapine for the Management of ICU Delirium: A Randomized Clinical Trial
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 发起方
- Richard Hall
- 入组人数
- 200
- 试验地点
- 2
- 主要终点
- Resolution of delirium as indicated by an Intensive Care Delirium Screening Checklist score of less than 4
研究概览
简要总结
The purpose of this randomized clinical trial is to determine whether haloperidol is superior to olanzapine for the treatment of ICU acquired delirium. The hypothesis is that haloperidol is in fact superior to olanzapine in treating ICU acquired delirium and sustaining delirium free time.
详细描述
Delirium is defined as a disturbance of consciousness characterized by an acute onset of impaired cognitive function. Although delirium is thought to be common in the Intensive Care Unit (ICU) there are few studies that have evaluated its incidences, risks and outcomes. It has been associated with increased morbidity, and mortality and increased cost to the healthcare system. In addition to the uncertainty of the incidence of ICU delirium, there is a lack of information about the effects that certain pharmacological treatments have on delirious patients.
The standard pharmacological treatments for ICU acquired delirium are haloperidol and olanzapine as they have been shown to be equivalent in reducing its incidence. However, optimal dose and regimen have not been well defined.
The rationale for this study is to determine whether haloperidol is superior to olanzapine in the treatment of ICU acquired delirium. A secondary objective is to determine the most appropriate dosing regimen for the treatmet. The role of alternative agents quetiapine, risperidone, loxapine and methotrimeprazine will also be examined in a preliminary analysis.
Patients who develop agitation or delirium as defined by an Intensive Care Delirium Checklist (ICDSC) score of greater than or equal to 4 meeting all the inclusion criteria and no exclusion criteria will be eligible for randomization. Once randomized they will be screened for ongoing agitation and delirium as well prolongation of the QTc interval greater than 440 msec, development of extrapyramidal symptoms and development of a seizure disorder.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients who are 18 years or older who are admitted for more than 24 hours to the ICU.
- •Patients screened for delirium using the ICDSC with a score greater than or equal to 4 or with clinical manifestations of delirium.
排除标准
- •Patients unlikely to survive 24 hours.
- •Patients with a primary neurologic reason (i.e. stroke, dementia-related psychosis) for ICU admission.
- •Patients with QTc interval greater than 440 msec.
- •Pregnant patients.
- •Patients who are breast feeding.
- •Patients in whom haloperidol, or olanzapine is contraindicated.
- •Patients allergic to haloperidol, olanzapine, quetiapine, risperidone, loxapine or methotrimeprazine.
- •Patients who do not have a urinary catheter.
- •Patients who have received haloperidol, olanzapine, quetiapine, risperidone, loxapine or methotrimeprazine within 14 days.
- •Patients unable to undergo assessment (i.e. patients with developmental disability or mental incapacity prior to ICU admission).
- •Prolonged (greather than 24 hours) comatose patients who have a defined structural reason for their decreased level of consciousness.
研究组 & 干预措施
1
Haloperidol
干预措施: Haloperidol (Drug)
2
Olanzapine
干预措施: Olanzapine (Drug)
结局指标
主要结局
Resolution of delirium as indicated by an Intensive Care Delirium Screening Checklist score of less than 4
时间窗: Every 24 hours
次要结局
- Type of rescue medication(Every 24 hours)
- Delirium free days (i.e. time from resolution of delirium to ICU discharge)(Every 24 hours)
- If on mechanical ventilation at time delirium develops, duration of mechanical ventilation(Every 24 hours)
- Incidence of treatment failure at 48 hours(48 hours)
- Requirement for rescue medication(Every 24 hours)
- Mortality(Time of death)
研究者
Richard Hall
Dr. Richard Hall MD FRCPC FCCP
Nova Scotia Health Authority