Antipsychotic medications do not facilitate delirium or dementia in intensive care

Powerful drugs used for decades to treat delirium are ineffective for this purpose, according to a study published online Monday in the New England Journal of Medicine.

Antipsychotic medications, such as haloperidol (brand name, Haldol), are widely used in intensive care units, emergency rooms, hospital departments and retirement homes.

"In some surveys, up to 70% of patients [in the ICU] Dr. E. Wesley "Wes" Ely, intensive care specialist at the Vanderbilt University Medical Center, has prescribed these antipsychotic drugs. They are prescribed by "very good doctors in high performance medical centers," he says. "Millions of people around the world are getting these drugs to treat their delirium."

But medications can have serious side effects. And Ely says that there is no solid research showing that they are effective at treating delirium.

Delirious patients are often confused and inconsistent and can sometimes suffer from hallucinations. This condition can lead to long-term cognitive problems, including some form of dementia.

Ely and colleagues at 16 US medical centers have decided to test antipsychotics rigorously. They divided nearly 600 delirious patients into three groups. One group received the potent antipsychotic haloperidol. A second group received ziprasidone, a drug related to a class of drugs called "atypical antipsychotics". A third group received a placebo.

"The three groups did exactly the same thing," said Ely. The duration of delirium and the number of days without coma have not changed. "They stayed in the intensive care unit for the same time, they stayed under the mechanical ventilator for the same time, they did not get out of the hospital sooner."

"There is no evidence in this whole investigation that this aggressive approach to treating delirium with antipsychotics, which is a commonplace and habitual care, has done just about anything for patients," he concludes. .

Ely was to present his study results, called MIND-USA, at the meeting of the European Society of Critical Care Medicine in Paris today. Timed with this presentation, the New England Journal of Medicine published the document online.

Ely says that medications can calm patients and that he sometimes uses them for this purpose. They are also prescribed for severe depression, post-traumatic stress disorder, obsessive-compulsive disorder and other mental health issues. The new study only evaluated the value of these drugs for the treatment of delirium.

"It's huge!" Dr. Juliana Barr, Anesthetist and Critical Care Specialist at Stanford University and VA Palo Alto Medical Center, who did not participate in the study. She helped develop guidelines for proper use of drugs in the intensive care unit.

"I think the main message is that providers need to really think differently about the management of delirium in their ICU patients," she says. "A pill or an injection is really not a quick fix to this devastating disease."

Barr expects the new study to change medical practice. "This will radically change the way we think about the best practices of delirium management in the intensive care unit," she said.

Ely and she both advocate a more holistic approach to the treatment of delirium: freeing patients from their medications and respiratory system as soon as possible and lifting them as soon as possible.

You can contact Richard Harris at [email protected].

Copyright NPR 2018.