Proportional Sedation for Persistent Agitated Delirium in Palliative Care

What is the impact of haloperidol and/or lorazepam on restlessness and agitation in patients with advanced cancer and persistent agitated delirium in the palliative care setting?In this 4-parallel group, double-blind, randomized clinical trial including 72 patients, the lorazepam group had significantly lower Richmond Agitation-Sedation Scale (RASS) scores compared to the haloperidol alone group; the haloperidol plus lorazepam group also had significantly lower RASS scores compared to the haloperidol group. RASS scores did not differ significantly between haloperidol and placebo groups; however, the placebo group required significantly more rescue doses for breakthrough restlessness and agitation.These results indicate that for these patients, proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce breakthrough restlessness and agitation.

Corresponding Author: David Hui, MD, Department of Palliative, Rehabilitation and Integrative Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (dhui@mdanderson.org).

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