Marra A, Vargas M, Buonanno P, Iacovazzo C, Kotfis K, Servillo G
Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
Eur Rev Med Pharmacol Sci. 2021 Feb;25(3):1582-1591. doi: 10.26355/eurrev_202102_24868.
Delirium, a common behavioral manifestation of acute brain dysfunction in Intensive Care Unit (ICU), is a significant contributor to mortality and worse long-term outcome. Antipsychotics, especially haloperidol, are commonly administered for the treatment and prevention of delirium in critically ill patients while the evidence for the safety and efficacy of these drugs is still lacking. Therefore, we conducted a systematic review of the benefits of haloperidol for the prevention of delirium in ICU patients.
We made a systematic review and meta-analysis.
Eight RCTs with 2806 patients were included. The prophylactic use of haloperidol did not reduce the delirium incidence (RR: 0.90, 95% CI: 0.69-1.71), the duration of delirium (MD: -0.33, 95% CI: -1.25-0.588) and the delirium/coma free days (MD: 0.08, 95% CI: -0.06-0.23). We did not find an increase of extrapyramidal effects (RR: 1.86, 95% CI: 0.30-11.39), QTc prolongation (RR: 1.11, 95% CI: 0.79-1.55) and arrhythmias (RR: 1.26, 95% CI: 0.72-2.19). The use of haloperidol did not increase the ICU (MD: 0.77, 95% CI: -0.28-1.83) and hospital length of stay (MD: -0.57, 95% CI: -1.32-0.18). Haloperidol did not increase the sedation level (RR: 1.88, 95% CI: 0.76-4.63) and mortality (RR: 0.97, 95% CI: 0.83-1.18).
Haloperidol did not reduce the delirium incidence, the delirium duration, the delirium/coma free-days and did not increase the incidence of extrapyramidal effects, arrhythmias, the ICU and hospital length of stays and sedation.
谵妄是重症监护病房（ICU）急性脑功能障碍的常见行为表现，是导致死亡率升高和长期预后较差的重要因素。抗精神病药物，尤其是氟哌啶醇，常用于治疗和预防危重症患者的谵妄，但这些药物安全性和有效性的证据仍不足。因此，我们对氟哌啶醇预防ICU患者谵妄的益处进行了系统评价。
我们进行了系统评价和荟萃分析。
纳入8项随机对照试验，共2806例患者。预防性使用氟哌啶醇并未降低谵妄发生率（风险比：0.90，95%可信区间：0.69-1.71）、谵妄持续时间（平均差：-0.33，95%可信区间：-1.25-0.588）以及无谵妄/昏迷天数（平均差：0.08，95%可信区间：-0.06-0.23）。我们未发现锥体外系反应增加（风险比：1.86，95%可信区间：0.30-11.39）、QTc延长（风险比：1.11，95%可信区间：0.79-1.55）以及心律失常（风险比：1.26，95%可信区间：0.72-2.19）。使用氟哌啶醇并未增加ICU住院时间（平均差：0.77，95%可信区间：-0.28-1.83）和医院住院时间（平均差：-0.57，95%可信区间：-1.32-0.18）。氟哌啶醇未增加镇静水平（风险比：1.88，95%可信区间：0.76-4.63）和死亡率（风险比：0.97，95%可信区间：0.83-1.18）。
氟哌啶醇并未降低谵妄发生率、谵妄持续时间、无谵妄/昏迷天数，也未增加锥体外系反应、心律失常、ICU住院时间、医院住院时间以及镇静的发生率。
