Agitation control with clonidine and haloperidol in critically ill patients: A retrospective analysis

PURPOSE: To investigate the effects of clonidine and haloperidol on ICU agitation control.

METHODS: This cohort study included mixed ICU patients with at least one agitation episode (Richmond Agitation Sedation Scale [RASS] score > 1) treated with clonidine and/or haloperidol. Primary outcome was agitation control (-2 ≤ target RASS score ≤ 1) within six hours of medication administration, using propensity score matching and Markov multinomial logistic regression. We further explored associations with concomitant medication.

RESULTS: We analyzed 510 agitation episodes in 247 patients, with 273 (54 %) receiving clonidine only, 88 (17 %) haloperidol only, and 149 (29 %) both. Neither haloperidol only (OR 1.00, 95 %CI 0.57 to 1.76) nor administration of both medications (OR 0.83, 95 %CI 0.52 to 1.32) showed improved agitation control compared to clonidine only. Haloperidol only (adjusted difference - 44.8 mg, 95 %CI -89.1 to -0.5 mg) and both clonidine and haloperidol (adjusted difference - 48.4 mg, 95 %CI -85.6 to -11.1 mg) was associated with reduced propofol usage compared to clonidine only. Treatment with both clonidine and haloperidol was associated with lower opioid usage (adjusted difference - 52.3 mg, 95 %CI -93 to -11.7 mg). There was no difference in benzodiazepine administration.

CONCLUSION: This study found no difference in agitation control among ICU patients treated with clonidine, haloperidol or both.