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For 40 years, doctors have been prescribing powerful antipsychotic drugs to patients suffering from delirium. Haldol is a common one. But a sweeping new study finds those drugs are completely ineffective in treating delirium. The study was published online today in The New England Journal of Medicine. NPR's Richard Harris reports.
RICHARD HARRIS, BYLINE: Every intensive care unit nurse encounters delirious patients like Brian, a 47-year-old man who had been admitted to the ICU at Vanderbilt University Medical Center with a failing liver. When doctors swing through on a recent morning on their daily rounds, nurse Lindsey Smith recaps Brian's rough night.
LINDSEY SMITH: He is completely disoriented this morning. He couldn't even tell me his name. Mobility-wise, he can move all of his extremities. He's tried to get out of bed several times this morning. We ended up having to restrain him because the mittens were not getting over his hands.
HARRIS: In his confused, delirious state, he doesn't realize that the IV lines are actually providing him much-needed medicine.
SMITH: He has two peripheral IVs. Those are switching positions 'cause he keeps pulling them out.
WES ELY: Let's go see him.
HARRIS: Dr. Wes Ely and the team head into the room. He's concerned about bringing this man's delirium under control. If it persists, it can greatly increase the risk he will suffer long-term problems thinking and remembering.
ELY: Brian, hi. I'm Dr. Ely. How are you doing?
BRIAN: I'm all right.
ELY: What's the main thing bothering you today?
HARRIS: Brian can't seem to make sense of the question. Ely persists.
ELY: Hold up that many fingers. Hold it up with your hand.
HARRIS: Brian can't follow that simple command either. Ely says these are signs of delirium. Many doctors would give him a powerful antipsychotic such as Haldol or a related drug called ziprasidone. The assumption for decades is that these drugs could treat delirium.
ELY: In some surveys, up to 70 percent of patients get these antipsychotics in the hands of very good doctors at extremely good medical centers. And so that means, translation, worldwide that millions of people are getting these drugs to treat their delirium.
HARRIS: But that medical practice was based on tradition, not solid science. So Dr. Ely and his colleagues ran a formal clinical trial involving more than 500 patients to see if the drugs actually worked. Patients with delirium were split into three groups. One group got the most powerful antipsychotics. A second group got what's called an atypical antipsychotic - ziprasidone. A third group got placebo. Ely says the drugs made absolutely no difference.
ELY: Neither group had any detectable reduction in delirium, coma. They stayed in the ICU the same amount of time. They stayed on the mechanical ventilator the same amount of time. They didn't get out of the hospital any sooner one way or the other. And there's really not a shred of evidence in this entire investigation that this aggressive approach to treating delirium with antipsychotics, which is commonplace and usual care, did anything for the patients.
HARRIS: Yes, the drugs can calm patients down, but they don't treat delirium.
JULI BARR: This is huge.
HARRIS: Dr. Juli Barr at Stanford University has helped craft guidelines for appropriate drug use in the intensive care unit.
BARR: Providers really need to think differently about managing delirium in their patients in the ICU, that a pill or an injection's really not a magic bullet for this devastating illness.
HARRIS: Both she and Ely advocate for a more holistic approach to treating delirium by getting patients off drugs and off breathing machines as soon as possible and getting them up and about as soon as they're able. Richard Harris, NPR News.
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