TY - JOUR
T1 - Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium
T2 - a prospective cohort study
AU - Schrøder Pedersen, Sofie
AU - Kirkegaard, Thomas
AU - Balslev Jørgensen, Martin
AU - Lind Jørgensen, Vibeke
PY - 2014/4
Y1 - 2014/4
N2 - OBJECTIVES: Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could be increased. Length of stay (LOS), complications and 180-day mortality are reported.METHODS: Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression.RESULTS: Incidence of delirium after cardiac surgery was 21 (14-29) and 22 (15-30) %, onset was on postoperative day 1 (1-4) and 1 (1-3), duration was 1 (1-4) day and 3 (1-5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61-73) and 65 (60-70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and complications.CONCLUSIONS: We observed no increase in the proportion of delirium- and coma-free days after introduction of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium. Most patients were not severely affected, and the few who were, proved difficult to treat, indicating that a simple treatment protocol with haloperidol was ineffective.
AB - OBJECTIVES: Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary. Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could be increased. Length of stay (LOS), complications and 180-day mortality are reported.METHODS: Prospective interventional cohort study. One hundred and seventeen adult patients undergoing cardiac surgery were included before introduction of a screening and treatment protocol with haloperidol for delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol for standardized dosing with haloperidol was applied. Group comparison was done using non-parametric tests and analysis of fractions, and associations between delirium and predefined covariates were analysed with logistic regression.RESULTS: Incidence of delirium after cardiac surgery was 21 (14-29) and 22 (15-30) %, onset was on postoperative day 1 (1-4) and 1 (1-3), duration was 1 (1-4) day and 3 (1-5) days, respectively, with no significant difference (Period 1 vs 2, all values are given as the median and 95% confidence interval). The proportion of delirium- and coma-free days was 67 (61-73) and 65 (60-70) %, respectively (ns). There was no difference in LOS or complication rate. Delirium was associated to increasing age, increased length of stay and complications.CONCLUSIONS: We observed no increase in the proportion of delirium- and coma-free days after introduction of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium. Most patients were not severely affected, and the few who were, proved difficult to treat, indicating that a simple treatment protocol with haloperidol was ineffective.
KW - Adult
KW - Aged
KW - Antipsychotic Agents
KW - Cardiac Surgical Procedures
KW - Checklist
KW - Chi-Square Distribution
KW - Delirium
KW - Denmark
KW - Early Diagnosis
KW - Female
KW - Haloperidol
KW - Humans
KW - Length of Stay
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Young Adult
U2 - 10.1093/icvts/ivt501
DO - 10.1093/icvts/ivt501
M3 - Journal article
C2 - 24357472
SN - 1569-9293
VL - 18
SP - 438
EP - 445
JO - Interactive Cardiovascular and Thoracic Surgery
JF - Interactive Cardiovascular and Thoracic Surgery
IS - 4
ER -