PURPOSE: Intravenous haloperidol use in intensive care unit (ICU) is known to be associated with arrhythmias like Torsades de Pointes(TdP) when used for prevention and treatment of delirium.The purpose of our study is to review complications including TdP in patients who received intravenous haloperidol, and its effects on number of re-intubations and length of ICU stay.
METHODS: Randomly selected 66 patients on mechanical ventilation for more than 72 hours were evaluated retrospectively.Patients with cardiac events within past 30 days and tracheostomies were excluded.Non-sustained ventricular tachycardia (NSVT) ≥ 6 seconds and TdP were identified.Serum electrolytes, QT prolongation (QTP) before and after Haloperidol administration, and use of medications known to cause QTP were recorded.
RESULTS: 18/66(27.3%) patients received intravenous haloperidol, median dose and mean age was 10mg (r=2-97) and 58 years(range=21-87).No patients in haloperidol group had arrhythmia as compared to 10 in non-haloperidol group (p=0.03).Mean serum potassium and magnesium pre-intubation were 3.97 mEq/L (range=2.9-4.7) and 1.8 mEq/L (range=1.4-2.9) respectively.Mean QTc pre and post-haloperidol were 456 (range=389-516) and 394 (range=370-494) milliseconds respectively. In non-haloperidol group,10/48(21%) patients had arrhythmias,but no TdP.There was no clinically significant difference in mean age 56.7 years (range=22-87),serum potassium and magnesium from haloperidol group.Mean QTc was 446 (range=401-567) pre-intubation and 437 milliseconds(range=390-491) post-extubation. 25/48(52.3%) patients in non-haloperidol group had QTP medications versus 14/18(77.7%) in haloperidol group (p=0.05).Average length of intubation and ICU stay were similar in both groups.
CONCLUSIONS: In the absence of predisposing factors like hypokalemia, hypomagnesemia, prolonged QTc and other medications causing QTP, incidence of malignant arrhythmias with intravenous haloperidol is extremely rare (zero in our study).On the other hand,use of haloperidol did not show any benefit in terms of decreasing rates of re-intubation,length of intubation or ICU length of stay.
CLINICAL IMPLICATIONS: Haloperidol is an efficacious drug for management of delirium.Our study provides a stage to believe in its safety in ICU as long as the predisposing factors are well controlled, though the benefits in terms of decreasing re-intubations and length of ICU stay were not significant.
DISCLOSURE: The following authors have nothing to disclose: Naveed Hasan, Shea Eckerdt, Naveed Akhtar, Luke Yuhico, Sujith Cherian, Shraddha Goyal, Gayathri Sathiyamoorthy, William Darko, Birendra Sah, Ioana Amzuta
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