Quetiapine vs. Haloperidol for Hyperactive Delirium
Trial question
What is the effect of quetiapine in critically ill patients with hyperactive delirium?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
60.0% female
40.0% male
N = 100
100 patients (60 female, 40 male).
Inclusion criteria: adult patients in the ICU with hyperactive delirium.
Key exclusion criteria: suspected substance-induced delirium; previous use of antipsychotics; known allergy or intolerance to the study drugs; pregnancy or lactation; acute renal injury; hepatic failure; head trauma; recent CNS hemorrhage or stroke.
Interventions
N=50 quetiapine (oral or nasogastric dose of 25-50 mg/day).
N=50 haloperidol (oral or nasogastric dose of 1-2 mg/day).
Primary outcome
Response rate
96%
88%
96.0 %
72.0 %
48.0 %
24.0 %
0.0 %
Quetiapine
Haloperidol
No significant
difference ↔
No significant difference in response rate (96% vs. 88%; AD 8%, 95% CI -21.63 to 37.63).
Secondary outcomes
No significant difference in death in the ICU (16% vs. 28%; ARD -12, 95% CI -45.77 to 21.77).
No significant difference in death in the hospital (16% vs. 32%; ARD -16, 95% CI -47.3 to 15.3).
Significant increase in ICU stay (10.1 days vs. 11.7 days; AD 1.6 days, 95% CI 0.27 to 2.93).
Conclusion
In adult patients in the ICU with hyperactive delirium, quetiapine was not superior to haloperidol with respect to response rate.
Reference
Tamer Zakhary, Islam Ahmed, Ibrahim Luttfi et al. Quetiapine Versus Haloperidol in the Management of Hyperactive Delirium: Randomized Controlled Trial. Neurocrit Care. 2024 Oct;41(2):550-557.
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