Efficacy and safety of haloperidol for delirium prevention in adult patients: An updated meta-analysis with trial sequential analysis of randomized controlled trials

作者：Zhen Chen, Rui Chen, Donghua Zheng, Yongpeng Su, Shuchao Wen, Huocheng Guo, Zhigang Ye, Yingxin Deng, Genglong Liu, Liuer Zuo, Xuxia Wei, Yunqi Hou · 发表于：Journal of Clinical Anesthesia · 年份：2019 · DOI：10.1016/j.jclinane.2019.09.017 · 被引用次数：17 · 研究领域：Intensive Care Unit Cognitive Disorders、Nosocomial Infections in ICU、Sepsis Diagnosis and Treatment

STUDY OBJECTIVE: To identify the efficacy and safety of haloperidol prophylaxis in adult patients with a high risk for delirium. DESIGN: A meta-analysis with trial sequential analysis of randomized controlled trials. INTERVENTION: A comprehensive search was performed in PubMed, the ISI Web of Knowledge, the Cochrane Library, and Embase databases from inception through to March 2019.Citation screening, data abstraction and quality assessment were performed in duplicate. Meta-analysis with trial sequential analysis (TSA) were used to assess the primary and secondary outcomes. In addition, we used the Grading of Recommendations Assessment Development and Evaluation (GRADE) to evaluate the certainty of the body of evidence. MAIN RESULTS: We appraised 8 RCTs involving 3034 patients that that were in compliance with inclusion and exclusion criterion. Pooled analyses indicated patients receiving haloperidol prophylaxis and placebo or normal saline did not significantly differ in incidence of delirium (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.70 to 1.15), with TSA inconclusive. Notably, compared with the control group, use of haloperidol significantly decreased the duration of delirium (Mean difference [MD] -0.94; 95% CI -1.82 to -0.06 days), with a marked heterogeneity. Additionally, haloperidol prophylaxis does not significantly affect duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay and mortality. In terms of ...