Intensive Care and Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.
Pediatr Crit Care Med. 2018 Feb;19(2):e112-e119. doi: 10.1097/PCC.0000000000001414.
As delirium in critically ill children is increasingly recognized, more children are treated with the antipsychotic drug haloperidol, while current dosing guidelines are lacking solid evidence and appear to be associated with a high risk of adverse events. We aim to report on the safety and efficacy of a recently implemented clinical dose-titration protocol with active monitoring of adverse events.
From July 2014 until June 2015, when a potential delirium was identified by regular delirium scores and confirmed by a child psychiatrist, haloperidol was prescribed according to the Dutch Pediatric Formulary. Daily, adverse events were systematically assessed, haloperidol plasma concentrations were measured, and delirium symptoms followed. Dependent on the clinical response, plasma concentration, and adverse event, the dose was adjusted.
A 28-bed tertiary PICU in the Netherlands.
All patients admitted to the PICU diagnosed with delirium.
Treatment with haloperidol according to a dose-titration protocol MEASUREMENTS AND MAIN RESULTS:: Thirteen children (median age [range] 8.3 yr [0.4-13.8 yr]) received haloperidol, predominantly IV (median dose [range] 0.027 mg/kg/d [0.005-0.085 mg/kg/d]). In all patients, pediatric delirium resolved, but five of 13 patients developed possible adverse event. These were reversed after biperiden (n = 2), discontinuing (n = 3), and/or lowering the dose (n = 3). Plasma concentrations were all below the presumed therapeutic threshold of 3-12 µg/L.
Prospective systematic monitoring of adverse event in critically ill children receiving haloperidol revealed a significant proportion of possible adverse events. Adverse event developed despite low plasma concentrations and recommended dose administration in the majority of the patients. Our data suggest that haloperidol can potentially improve pediatric delirium, but it might also put patients at risk for developing adverse events.
随着人们对危重病儿童谵妄认识的不断提高，越来越多的儿童接受了抗精神病药物氟哌啶醇治疗，而目前的剂量指南缺乏确凿的证据，且似乎存在发生不良事件的高风险。我们旨在报告最近实施的一项临床剂量滴定方案的安全性和疗效，该方案对不良事件进行了积极监测。
从 2014 年 7 月至 2015 年 6 月，当定期进行的谵妄评分发现疑似谵妄并经儿童精神病医生确诊后，根据荷兰儿科处方集开具氟哌啶醇。每天系统评估不良反应，测量氟哌啶醇的血浆浓度，并跟踪谵妄症状。根据临床反应、血浆浓度和不良反应调整剂量。
荷兰的一家 28 张病床的三级儿科重症监护病房。
所有被诊断为谵妄并收入儿科重症监护病房的患者。
根据剂量滴定方案用氟哌啶醇治疗。
13 名儿童（中位年龄[范围]8.3 岁[0.4-13.8 岁]）接受了氟哌啶醇治疗，主要为静脉内（中位剂量[范围]0.027mg/kg/d[0.005-0.085mg/kg/d]）。所有患者的小儿谵妄均得到缓解，但 13 名患者中有 5 名出现了可能的不良反应。在 2 名患者中使用了比哌立登，在 3 名患者中停止用药，在 3 名患者中降低了剂量后，这些不良反应得到了逆转。所有血浆浓度均低于假定的 3-12μg/L 治疗阈值。
对接受氟哌啶醇治疗的危重病儿童进行前瞻性系统的不良反应监测显示，不良反应的比例较高。尽管大多数患者的血浆浓度较低且推荐剂量给药，但仍出现了不良反应。我们的数据表明，氟哌啶醇可能改善小儿谵妄，但也可能使患者面临发生不良反应的风险。
