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

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

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.

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.

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