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Comment & Response
July 17, 2018

Prophylactic Haloperidol for Critically Ill Adults

Author Affiliations
  • 1Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
  • 2Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
JAMA. 2018;320(3):303-304. doi:10.1001/jama.2018.6045

To the Editor The Prophylactic Haloperidol Use for Delirium in ICU Patients at High Risk for Delirium (REDUCE) trial found that prophylactic haloperidol did not improve survival at 28 days compared with placebo.1 Despite the authors’ attempt to capture an at-risk patient population, the enrolled patients did not have many of the risk factors known to be associated with the development of delirium.2 The mean age of enrolled patients was 67 years, baseline hypertension was not reported, and patients with a history of dementia, alcohol abuse, and psychiatric disorders were excluded. The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19. Two-thirds of patients were mechanically ventilated with 41% having acute respiratory failure. One-third of patients had sepsis, and the mean prediction of delirium in ICU patients score was 26. These variables suggest that patients may not have been at high risk of delirium.