Antipsychotics ineffective for treating ICU delirium: study

From the Winter 2019 edition of Vanderbilt Medicine Magazine

Photo by Anne Rayner

Critically ill patients are not benefiting from antipsychotic medications that have been used to treat delirium in intensive care units (ICUs) for more than four decades, according to a study released in October 2018 in the New England Journal of Medicine.

Each year, more than 7 million hospitalized patients in the United States experience delirium, making them disoriented, withdrawn, drowsy or difficult to wake.

The large, multi-site MIND USA (Modifying the INcidence of Delirium) study sought to answer whether typical and atypical antipsychotics — haloperidol or ziprasidone — affected delirium, survival, length of stay or safety.

“We found, after extensive investigation with medical centers all over the country, that the patients who get these potentially dangerous drugs are not experiencing any improvements whatsoever in delirium, coma, length of stay or survival,” said senior author by E. Wesley Ely, MD, MPH, professor of Medicine at Vanderbilt University School of Medicine, associate director of Research for the VA Geriatric Research Education Clinical Center, and co-director of the CIBS (Critical Illness, Brain dysfunction, and Survivorship) Center.

Researchers screened nearly 21,000 patients at 16 U.S. medical centers. Of the 1,183 patients on mechanical ventilation or in shock, 566 became delirious and were randomized into groups receiving either intravenous haloperidol, ziprasidone or placebo (saline).

The investigators found no significant difference in duration of delirium or coma among participants on haloperidol or ziprasidone compared to placebo.

Similarly, there were no significant differences among participants on either antipsychotic medication compared to placebo in 30-day and 90-day mortality or time on the ventilator, or in the ICU and hospital.

“Every day, there are many thousands of patients receiving unnecessary antipsychotics in the critical care setting that are bringing risk and cost without benefit with respect to the outcomes measured in this NIA-sponsored MIND-USA study,” Ely said.

The MIND USA study was funded by the National Institute on Aging, part of the NIH, with grant AG035177. The ICU Liberation Collaborative, also released in October 2018, was funded by the Gordon and Betty Moore Foundation through the Society of Critical Care Medicine (SCCM).