From the Department of Intensive Care Medicine, Radboud Institute Health Science, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (P.J.T.R., M.Z., J.G.v.d.H., P.P., M.v.d.B.) the Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (A.J.C.S.) the Department of Intensive Care Medicine, Medical Spectrum Twente, Enschede, The Netherlands (A.B.) the Department of Intensive Care Medicine, Jeroen Bosch Hospital Den-Bosch, The Netherlands (K.S.S.) the Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (P.H.J.v.d.V.) the Tilburg Institute for Academical Studies School for Business and Society, Tilburg University, Tilburg, The Netherlands (P.H.J.v.d.V.) the Department Intensive Care Medicine, Zuyderland Medical Center, Heerlen, The Netherlands (M.C.E.v.d.W.) the Department Intensive Care Medicine, Gelre Hospital, Apeldoorn, The Netherlands (P.E.S.).
Anesthesiology. 2019 Aug;131(2):328-335. doi: 10.1097/ALN.0000000000002812.
Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life.
A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed.
Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 ± 11 and 39 ± 11, respectively, and P = 0.350; and mental component summary score of 50 ± 10 and 51 ± 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life.
Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
重症监护病房患者发生谵妄的发病率较高，且与长期预后受损相关。在有发生谵妄高危风险的危重症成人中，预防性使用氟哌啶醇并未改善短期预后。本研究评估了该组患者中预防性使用氟哌啶醇对长期生活质量的影响，并探讨了哪些因素与生活质量的变化相关。
对高风险谵妄（REDUCE）研究中预防性使用氟哌啶醇治疗 ICU 谵妄高危患者的长期结局进行了预先计划的二次分析。在这项多中心随机临床试验中，非谵妄的 ICU 患者被分配至预防性氟哌啶醇（1 或 2 mg）或安慰剂（0.9%氯化钠）组。在所有组中，患者最终接受研究药物治疗的中位时间为 3 天[四分位间距，2 至 6]，直至发生谵妄或直至 ICU 出院。使用 12 项简短健康调查问卷在 ICU 入院时（基线）和 1 个月和 6 个月后评估长期结局。生活质量总结为生理成分综合评分和心理成分综合评分。分析氟哌啶醇组和安慰剂组之间的差异以及与生活质量变化相关的因素。
在 1789 例研究患者中，有 1245 例 ICU 患者被纳入，其中 887 例（71%）作出回应。氟哌啶醇组和安慰剂组之间的长期生活质量无差异（生理成分综合评分分别为 39 ± 11 和 39 ± 11，P = 0.350；心理成分综合评分为 50 ± 10 和 51 ± 10，P = 0.678）。年龄、内科和创伤入院、基线时的生活质量评分、谵妄风险（PRE-DELIRIC）评分以及镇静诱导昏迷天数与长期生活质量下降显著相关。
在有发生谵妄高危风险的危重症患者中，预防性使用氟哌啶醇不会影响长期生活质量。包括镇静诱导昏迷天数（可修正的因素）在内的多个因素与长期结局下降相关。
