USE OF HALOPERIDOL INFUSIONS TO CONTROL DELIRIUM IN CRITICALLY ILL ADULTS

OBJECTIVE: To describe and discuss the use of continuous intravenous i nfusions of haloperidol to treat severe delirium and agitation in 3 in tensive care unit (ICU) patients. CASE SUMMARIES: Three severely agita ted patients in ICU did not respond to conventional therapy with opiat es, benzodiazepines, and intermittent intravenous doses of haloperidol . In each case, control was achieved rapidly after initiation and titr ation of a continuous haloperidol infusion. Two patients had a history of schizophrenia. No adverse effects attributable to therapy were ide ntified. DISCUSSION: Haloperidol is often used in the ICU for control of severe agitation, even in patients without a psychiatric history. I t usually is given by bolus intravenous injection, sometimes in high d oses (>5 mg), even though that is not approved by the Food and Drug Ad ministration. Intravenous haloperidol is generally well tolerated, but multiform ventricular tachycardia has been reported. Experience with continuous haloperidol infusions is growing, and it appears to be an e ffective method for control of severe agitation or delirium. In our ex perience and in other limited published data, adverse effects are rare , but prolongation of the QT interval has occurred and multiform ventr icular tachycardia is likely a risk. CONCLUSIONS: In selected patients , a continuous infusion of haloperidol may be a useful alternative for control of agitation and delirium. Close monitoring for QT prolongati on or rhythm disturbances is mandatory.