Critical Care

Journal Article Annotations
2019, 1st Quarter

Critical Care

O. Joseph Bienvenu, MD, PhD
March 2019

  1. Factors associated with depression over time in head and neck cancer patients: a systematic review.

PUBLICATION #1 — Critical Care
Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness.
Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, Douglas IS, Malhotra A, Owens RL, Feinstein DJ, Khan B, Pisani MA, Hyzy RC, Schmidt GA, Schweickert WD, Hite RD, Bowton DL, Masica AL, Thompson JL, Chandrasekhar R, Pun BT, Strength C, Boehm LM, Jackson JC, Pandharipande PP, Brummel NE, Hughes CG, Patel MB, Stollings JL, Bernard GR, Dittus RS, Ely EW; MIND-USA Investigators. N Engl J Med. 2018 Dec 27;379(26):2506-2516


Type of study: Randomized controlled trial

The finding:  Neither ziprasidone nor haloperidol reduced the number of days alive without delirium or coma during the 14-day intervention period, compared with placebo.

Strength and weaknesses:  The authors conducted a rigorous, multisite clinical trial and measured a number of important secondary end points.  Unfortunately, the authors included allpatients with delirium, regardless of whether the patients were agitated or psychotic and frightened; thus, the results do little to inform how many of us practice.

Relevance:  Interestingly, despite lack of efficacy, both antipsychotics were as well tolerated as placebo.  This information is encouraging.  Future studies should probably limit the focus to delirious critically ill patients who are agitated and/or psychotic and frightened, as opposed to all delirious patients (most of whom have hypoactive delirium).