Personalized Sedation Goals for Agitated End-of-Life Delirium: Secondary Analysis of RECORD Trial.
Hsien Liang Huang, Shao-Yi Cheng, Jaw-Shiun Tsai et al.
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In 30 seconds
This preplanned secondary analysis of a multicenter, double-blind randomized trial assessed whether treatments achieved caregiver-defined personalized sedation goals in patients with advanced cancer and persistent agitated end-of-life delirium. Among 67 patients with available goals, achievement at 24 hours differed across treatment groups (P = 0.02). Goals were met by 10/13 (76.9%) receiving lorazepam, 8/13 (61.5%) receiving combination therapy, 7/13 (53.8%) receiving placebo, and 3/14 (21.4%) receiving haloperidol. Compared with haloperidol, lorazepam and combination therapy were more likely to achieve the goals.
Key findings
- At 24 hours, caregiver-defined sedation goals were achieved by 76.9% with lorazepam and 21.4% with haloperidol.
- Compared with haloperidol, lorazepam was associated with higher odds of goal achievement (odds ratio = 12.2; 95% CI = 2.0-75.1; P = 0.01).
- Combination therapy also had higher odds of goal achievement than haloperidol (odds ratio = 5.9; 95% CI = 1.1-32.0; P = 0.04).
Why it matters
Sedation targets in end-of-life delirium may differ according to caregiver preferences, so assessing whether treatment reaches an agreed goal adds a patient- and family-centred outcome to symptom management. In this analysis, lorazepam-based regimens more often met those targets than haloperidol alone, although the findings apply to a selected population with advanced cancer and persistent agitation.
What to keep in mind
This was a secondary analysis, and caregiver-defined goals were available for only 67 patients. The reported confidence intervals for treatment comparisons were wide.