Effect of Haloperidol on Stress Hormones and Quality of Sleep in Intensive Care Unit Patients with Delirium

Abstract

Purpose: The aim of this study describes patients and nurse’s perception of sleep and follows the trends of pituitary-adrenal-hormone activities among critically ill patients and to evaluate the effect of using haloperidol in ICU patients with acute oxidative stress at an academic level one hospital. The purpose was to determine the effect of haloperidol on patients’ stress hormones and oxidative stress and to evaluate benefits or disadvantages of using haloperidol in ICU patients with acute stress as well as patients’ self-assessment of sleep and nurses report of patient sleep. In addition, quantify haloperidol and tramadol in plasma and urine of patients’ by liquid-liquid extraction using sotalol as internal standard. The concentrations of cortisol and melatonin were also determined using ELISA-assay. Research method: This is a prospective study with quantitative approach, with data collected at multiple points during the patients’ admission. Data collection: The setting for the study was general intensive care unit at a university-affiliated, public sector and tertiary level health care institution in Gauteng Province, Johannesburg, South Africa . Data collected included clinical profile of the delirium patients and their perception of their sleep quality and factors that promoted or retarded their sleep. A pharmacokinetic profile of haloperidol and tramadol in the patients was evaluated from blood and urine samples using HPLC analysis. Elisa assay was also carried out to determine the plasma cortisol/ melatonin level. Results: The total number of participants was 94. The overall age was 45±0.49. There were more males 48 (51.06%) than females 46 (48.94%). The average length of stay was 3.4 days (range, 1-11 days). Only 20 (21.2%) critically ill patients were on haloperidol. The SAPS II score predicted mortality rate was 30.8% as against the precise ICU mortality rate of 14%. The total sleep score mean of 47.4±16.71 for patients receiving antipsychotic or sedatives (n=83) was significantly (p=0.009) lower than the rest of the patients (55.8±8.21). A correlation analysis showed some degree of correlation (r = 0.566; p < 0.001) between patients’ perception of sleep and nurses’ record. The linearity for haloperidol and tramadol was in the range of 1-200 ng/ml, run time of 3 minutes and the lower LLOD and LLOQ for haloperidol/tramadol both in mobile phase and in plasma. The percentage recovery was within the range of 80-102%. The ELISA-assay showed high level of cortisol among AKI patients with below average sleep quality. Conclusion: The study endorsed the use of the nurse’s record of patients’ sleep as reliable measure to report sleep quality in the ICU setting. The proposed method is simple, specific, linear, accurate, and precise and can be used for plasma haloperidol/tramadol detection in routine clinical practice, but not suitable for urine detection of these drugs.