Dexmedetomidine versus haloperidol for prevention of delirium during non-invasive mechanical ventilation

Background: Delirium is a common problem among intensive care patients and can contribute to non-invasive ventilation (NIV) failure. Prevention of delirium may improve the outcome and success rate of NIV. The aim of the current study was to compare the effects of using dexmedetomidine and haloperidol for prevention of delirium during NIV. Patients and methods: Ninety adult intensive care patients of ASA physical status III and IV on NIV were randomly allocated to three equal groups. Group D (30 patients) received dexmedetomidine continuous intravenous infusion of 0.2-0.7 mu g/kg/h preceded by a loading dose of 1.0 mu g/kg intravenously over 10 min if needed, group H (30 patients) received haloperidol continuous intravenous infusion of 0.5-2 mg/h preceded by a loading dose of 2.5 mg intravenously if needed and group P (30 patients) received normal saline infusion. Supplementary sedation or analgesia was given when needed. Our primary outcome measure was the incidence of delirium. Duration of non-invasive mechanical ventilation, incidence of endotracheal intubation during NIV, length of ICU stay, and length of hospital stay, adverse events and mortality were recorded. Delirium was diagnosed using the Confusion Assessment Method for the ICU (CAM-ICU). Hemodynamic parameters and respiratory rate were recorded. Results: The incidence of delirium was significantly lower in dexmedetomidine group 3/30 (10%) than haloperidol 10/30 (33.3%) and placebo groups 13/30 (43.3%) groups. Duration of NIV was significantly shorter in dexmedetomidine group than in placebo group and shorter than haloperidol group. The incidence of endotracheal intubation was significantly less in dexmedetomidine group compared to placebo and haloperidol groups. The length of ICU and hospital stay was significantly shorter in dexmedetomidine group compared to haloperidol and placebo groups Bradycardia occurred significantly more in dexmedetomidine group while prolonged corrected QT (QTc) interval occurred only in haloperidol group (2 patients). A significantly lower incidence of respiratory tract infections was noted in dexmedetomidine group. The need for supplementary sedatives and analgesic was significantly less in dexmedetomidine group compared to haloperidol and placebo groups. Conclusion: Dexmedetomidine is more effective than haloperidol for prevention of delirium during NIV with lower incidence of endotracheal intubation and shorter ICU and hospital stay. Bradycardia is more frequent with dexmedetomidine use. (C) 2016 Publishing services by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.