A 68-year-old man in the medical ICU for severe sepsis with multi-organ dysfunction is on assist-control ventilation and a norepinephrine infusion via central venous catheter. During nursing rounds, he is noted to be disoriented to time and place, pulling at his lines, and exhibiting fluctuating attention. His clinical status prompts consideration of pharmacologic intervention for hyperactive delirium. Which of the following is the most appropriate pharmacologic consideration for this patient’s delirium?

A 65-year-old mechanically ventilated man in the ICU has developed hyperactive delirium despite optimized non-pharmacologic measures. Based on current evidence from major randomized trials, which of the following best describes the expected effect of initiating haloperidol on key clinical outcomes in this setting?

A 72-year-old man with a history of heart failure and chronic kidney disease is admitted to the medical intensive care unit for septic shock. He is currently on pressure-support mechanical ventilation and a continuous norepinephrine infusion via a right internal jugular central line. Over the past 24 hours, he has become increasingly disoriented, fluctuating between drowsiness and hypervigilance, and is attempting to pull at his lines. His Confusion Assessment Method for the ICU (CAM-ICU) is positive. Which of the following is the most appropriate pharmacologic approach to managing this patient’s delirium?

A 72-year-old man has been in the ICU for three days following admission for acute respiratory failure. He remains on assist-control mechanical ventilation and is sedated with a propofol infusion titrated to a RASS goal of –2. Early mobilization and reorientation have been attempted. This morning he is noted to be hyperactive (RASS +2), pulling at his endotracheal tube and IV lines, and his CAM-ICU is positive for delirium. Vital signs are T 37.2°C, HR 100 bpm, BP 130/75 mmHg, RR 18/min, SpO₂ 96% on FiO₂ 0.5. Which of the following is the most appropriate initial management strategy for his delirium?

A 72-year-old man with septic shock is on assist-control ventilation and a continuous norepinephrine infusion at 0.08 mcg/kg/min via a right internal jugular central line. During evening rounds, he is noted to be disoriented to time and place, pulling at his lines, and attempting to self-extubate. His CAM-ICU is positive for hyperactive delirium. Vital signs: HR 98 bpm, BP 110/65 mmHg, RR 18 breaths/min, SpO₂ 96%. Which of the following is the most appropriate initial pharmacologic intervention for his delirium with dangerous agitation?

A 72-year-old man in the medical ICU is receiving assist-control ventilation and a norepinephrine infusion via a right internal jugular central line for septic shock. During evening rounds he is noted to be disoriented, picking at his lines, and attempting to self-extubate. His CAM-ICU is positive and his RASS is +3. According to the 2018 SCCM PADIS guidelines, which of the following pharmacologic agents has no evidence supporting its use as a primary treatment to reduce delirium duration or improve outcomes in critically ill adults?

A 72-year-old man admitted for severe sepsis and acute respiratory distress syndrome is in the ICU. He is on pressure support ventilation, and a central venous catheter is in place. Three days ago, he developed delirium (CAM-ICU positive) with a RASS of +2, for which scheduled haloperidol 1 mg IV every 6 hours was initiated. Over the past 24 hours, his vasopressor has been weaned off, and his CAM-ICU is now negative. He is calm and alert (RASS 0) and is following commands. Which of the following is the most appropriate action regarding the patient’s haloperidol therapy at this time?

A 62-year-old man with baseline intact cognition is three days post–abdominal surgery and remains intubated on assist-control ventilation in the ICU. Per unit protocol (PADIS guidelines), sedation is managed with a propofol infusion targeting a Richmond Agitation–Sedation Scale (RASS) of –1 to 0; he is receiving propofol at 1.2 mg/kg/hr via a central line. On a routine assessment he is disoriented, pulling at his lines, and attempting self-extubation with a RASS of +3. Two hours ago he received haloperidol 0.25 mg IV with minimal improvement. Vital signs are stable (BP 120/70 mmHg, HR 88 bpm, RR 18 breaths/min, SpO₂ 96%) and QTc is 430 ms. Which of the following is the most appropriate next step in management?

A 65-year-old man admitted to the ICU for severe sepsis is on mechanical ventilation with a continuous norepinephrine infusion via a central venous catheter. Over the past 24 hours, he has experienced fluctuating mental status changes. During morning rounds, he was lethargic, difficult to arouse, and responsive only to painful stimuli. Later, nursing staff reported he became acutely agitated, attempting to pull at his endotracheal tube and central line, and appeared to be hallucinating. His Richmond Agitation-Sedation Scale (RASS) score fluctuated between –3 (moderate sedation) and +2 (agitated), and his Confusion Assessment Method for the ICU (CAM-ICU) score was positive. Based on these fluctuating presentations, which subtype of delirium is most consistent with these findings?

A 72-year-old man is admitted to the intensive care unit for severe sepsis and is receiving mechanical ventilation with a continuous propofol infusion. He develops hyperactive delirium, evidenced by agitation, pulling at lines, and disorientation, despite appropriate sedation weaning. His Richmond Agitation-Sedation Scale (RASS) score fluctuates between −1 and +2, and his Confusion Assessment Method for the ICU (CAM-ICU) is positive. The clinical team is considering pharmacologic interventions. Which of the following statements most accurately describes the evidence for using haloperidol to treat delirium in this patient population?