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Comment & Response
July 17, 2018

Prophylactic Haloperidol for Critically Ill Adults—Reply

Author Affiliations
  • 1Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
  • 2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
JAMA. 2018;320(3):304-305. doi:10.1001/jama.2018.6049

In Reply Drs Strik and Schieveld ask why survival was the primary outcome of the REDUCE study. We chose survival based on a previous study1 and because this is an unequivocal, clinically relevant outcome. We hypothesized that prophylactic haloperidol would improve ICU patients’ 28-day survival compared with placebo by 15%.

We agree with Drs Torbic and Duggal that our study enrollment was not limited to the highest-risk patients only but based on expected length of ICU stay of more than 1 day, a surrogate measure of risk. Our practical approach enabled us to enroll patients immediately following ICU admission and determine the effect of prophylactic haloperidol in different groups varying from lower to higher risk of delirium. In all different delirium risk groups, including the highest one, we did not find any effect of prophylactic haloperidol in ICU patients.