A Comparison of Dexmedetomidine and Haloperidol in Patients With Intensive Care Unit (ICU)-Associated Agitation and Delirium

This study has been completed.
Sponsor:
Collaborator:
The Alfred
Information provided by (Responsible Party):
Rinaldo Bellomo, Austin Health
ClinicalTrials.gov Identifier:
NCT00505804
First received: July 23, 2007
Last updated: January 22, 2013
Last verified: January 2013
  Purpose

The purpose of the study is to determine whether dexmedetomidine is a more effective medication than haloperidol in the treatment of agitation and delirium in patients receiving mechanical ventilation in an intensive care unit. Haloperidol is a medication conventionally used for this purpose.

The investigators will study only patients who have recovered from their illness to the point that, were it not for agitation and delirium, they would no longer require mechanical ventilation.

The investigators hypothesize that patients receiving dexmedetomidine will be able to discontinue mechanical ventilation earlier than those receiving haloperidol.


Condition Intervention Phase
Delirium
Agitation
Ventilator Weaning
Respiration, Artificial
Intensive Care
Drug: dexmedetomidine
Drug: haloperidol
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomised Open Label Pilot Study of the Efficacy of Dexmedetomidine and Haloperidol in Ventilated Patients With ICU-associated Agitation and Delirium

Resource links provided by NLM:


Further study details as provided by Austin Health:

Primary Outcome Measures:
  • Time from the commencement of treatment to extubation [ Time Frame: days ] [ Designated as safety issue: No ]
    the tiem taken to extubate the patient


Secondary Outcome Measures:
  • Time taken to achieve a satisfactory sedation score (score 3 or 4 on the Riker scale) [ Time Frame: hours ] [ Designated as safety issue: No ]
    time to sedation score

  • The need for supplemental sedative and analgesic medication (morphine, midazolam or propofol, as clinically indicated) [ Time Frame: During delivery of trial medication ] [ Designated as safety issue: No ]
  • Average Riker score for agitation [ Time Frame: During delivery of trial medication ] [ Designated as safety issue: No ]
  • Average RASS score for agitation [ Time Frame: During delivery of trial medication ] [ Designated as safety issue: Yes ]
  • Need for re-intubation [ Time Frame: During the same ICU admission ] [ Designated as safety issue: Yes ]
  • Average Bergeron ICDSC score for delirium [ Time Frame: During delivery of trial medication ] [ Designated as safety issue: No ]
  • Duration of ICU stay [ Time Frame: days ] [ Designated as safety issue: Yes ]

Enrollment: 20
Study Start Date: January 2005
Study Completion Date: November 2008
Primary Completion Date: November 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Drug: dexmedetomidine
Dexmedetomidine IV infusion of 0.0 to 0.7 mg/kg/min for as long a deemed necessary by the treating clinician.
Active Comparator: 2 Drug: haloperidol
Haloperidol IV loading dose of 2.5mg, followed by a continuous infusion of 0.0 to 2mg/hr for as long as deemed necessary by the treating clinician

Detailed Description:

Up to 80% of patients undergoing intensive care have delirium. Early in the ICU stay, delirium and agitation are usually prevented using analgesic and sedative drugs which essentially render the patient unconscious. This is appropriate in the context of aggressive treatment of pathophysiological instability, which often requires multiple painful procedures. However, after the underlying pathophysiological problem has resolved, patients sometimes remain delirious and agitated. This often requires ongoing heavy sedation, which in turn necessitates continued mechanical ventilation, and can worsen the (temporarily masked) delirium. Prolonged mechanical ventilation increases the risk of ventilator associated pneumonia and other life threatening complications.

The drug most commonly used to treat delirium is haloperidol, which reduces hallucinations and unstructured thought patterns, but also reduces the interaction with the environment. Haloperidol has significant side effects, including extrapyramidal reactions (in 1-10% of patients), neuroleptic malignant syndrome (in which it is the cause in 50% of cases), and prolonged QT syndrome (which can precipitate fatal arrhythmias).

An ideal sedative agent in this context would have fewer side effects, relieve agitation without causing excessive sedation, and be easily titrated. An analgesic action might allow less opioid use, also lessening delirium. Early studies in other contexts suggest dexmedetomidine has all these properties.

The investigators hypothesise that patients with ICU-associated delirium after the resolution of their underlying pathological process who receive dexmedetomidine will be able to be extubated earlier than those who receive haloperidol.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients will be eligible for the study if, in the opinion of the treating clinician, they continue to require mechanical ventilation only because their degree of agitation requires such a high dose of sedative medication (midazolam or propofol, the only commonly used specific sedatives in our unit) that extubation is not possible.

Exclusion Criteria:

  • Patients who could not be extubated even if delirium or agitation were corrected. This will include:

    • Patients receiving high dose opioid analgesia (>20 m/morphine/day)
    • Patients shortly to return to the operating theatre
    • Patients undergoing repeated invasive procedures, in whom it is desirable to maintain deep sedation.
    • Patients likely to require ongoing airway protection or control, or ventilatory support (for example, spinal patients with an inadequate vital capacity)
  • Known allergy to haloperidol or alpha2 agonists
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00505804

Sponsors and Collaborators
Austin Health
The Alfred
Investigators
Principal Investigator: Rinaldo Bellomo, MD FJFICM Austin Health, University of Melbourne
Study Director: Michael C Reade, MBBS FJFICM Austin Health, University of Melbourne
  More Information

No publications provided by Austin Health

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Rinaldo Bellomo, Prof, Austin Health
ClinicalTrials.gov Identifier: NCT00505804     History of Changes
Other Study ID Numbers: H2004/02026
Study First Received: July 23, 2007
Last Updated: January 22, 2013
Health Authority: Australia: Department of Health and Ageing Therapeutic Goods Administration

Keywords provided by Austin Health:
dexmedetomidine
haloperidol

Additional relevant MeSH terms:
Delirium
Psychomotor Agitation
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Dyskinesias
Psychomotor Disorders
Haloperidol
Haloperidol decanoate
Dexmedetomidine
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Gastrointestinal Agents
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Dopamine Antagonists
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on August 18, 2014