Journal Article Annotations
2019, 1st Quarter
O. Joseph Bienvenu, MD, PhD
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).