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THE EFFICACY AND THE SAFETY OF DEXMEDETOMIDINE, HALOPERIDOL AND DIAZEPAM FOR TREATMENT OF DELIRIUM: A COMPARATIVE STUDY


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Abstract

Purposes of the study: comparative evaluation of the efficacy and safety of dexmedetomidine, haloperidol and diazepam for sedation and treatment of spontaneously breathing ICU patients with delirium. Material and Methods. We include 66 spontaneously breathing patients with delirium (ISDSC (Intensive Care Delirium Screening Checklist) ≥ 4 points) in the prospective single-centre randomized trial in parallel groups. In dexmedetomidine group (n = 20) we start iv dexmedetomidine 0.7 mcg/kg/h with dose titration from 0.2 to 1.2 mcg/kg/h based on sedation level (the goal was -1(-2) RASS points). In diazepam group (n = 25) we start from 20 mg diazepam iv, in case of insufficient sedation dose were increased gradually: first 40 mg/day, then 50-60 mg/day (dose were titrated individually based on level of agitation and body weight). In haloperidol group we start from 5 mg iv, in case of insufficient sedation dose were increased gradually: first 10 mg, then 15 mg/day. Regression of disorientation, hallucinations and agitation were used as criteria for efficacious delirium treatment. We calculate DSM-4, CAM-ICU, ISDSC and RASS everyday (the biggest value during the day). Also we recorded presence of disorientation, agitation and hallucinations and side effects- hypotension, bradycardia and hypoxemia every day. Results. Delirium duration was 3 (2; 4) days in dexmedetomidine group, 5(4; 6) days in haloperidol group and 6 (4; 8) days for diazepam group (p = 0.008). During the first 5 days ISDCS score decreased in all patients which were more pronounced in dexmedetomidine group, in haloperidol group ISDSC score were higher during 5 days, in diazepam group 13 patients had delirium on the 5th day (p < 0.033 from 24 to 96 h). In dexmedetomidine group disorientation revealed only in 30% patients after 48 h and only 1 patient had disorientation on the 4th day but in haloperidol group disorientation revealed in 66.7% of patients up to 4th day and in diazepam group - 60% of patients on the 4th day (p < 0.005 from 24 to 120 h). Hallucinations were present in 60 and 61.9% of patients in haloperidol and diazepam group on the 4th day, respectively. In dexmedetomidine group hallucinations were recorded only in 1 patient on the 4th day, and were absent in 55% of patients at 48 h (p<0.003 from 48 to 120 h). Hypotension was recorded if dexmedetomidine dose increased more than 1.0 mcg/kg/h and haloperidol dose 15 mg/day (n = 3). Bradycardia was recorded in 1 patient in dexmedetomidine group. Hypoxemia were recorded if diazepam dose was 50-60 mg/day (n = 17) and haloperidol dose was 15 mg/day (n = 18). Conclusion. Use of dexmedetomidine in comparision with haloperidol and diazepam for treatment of spontaneously breathing ICU patients with delirium leads to controlled level of light sedation and more rapid regression of agitation, disorientation and hallucinations with less frequency of side effects.


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