Rapid tranquilization in a psychiatric emergency room: A naturalistic cohort study in 12 h

The purpose of this study was to conduct a naturalistic assessment of the efficacy of four distinct fast tranquilization techniques (intramuscular haloperidol, midazolam, haloperidol plus promethazine, or haloperidol plus midazolam) over a period of 12 h. The sample included 1603 people who were psychiatric emergency room patients at Hospital Geral de Palmas in Brazil between January 2018 and June 2022. The primary outcome was the number and proportion of patients who achieved the ideal response of the rapid tranquilization concept: tranquil without sedation in all assessments (measure by BARS scale), without restraint, without additional medication and without side effects. The secondary outcomes were mild agitation, tranquil or asleep over 12 h, the need for additional medication, use of physical restraints, and side effects. Among all patients, the proportion of rapid tranquilization over 12 h was 14.1% besides (32.9% for haloperidol, 29.2% for midazolam, 4.1% for haloperidol plus promethazine, and 5.4% for haloperidol plus midazolam) there is response some time in 97%. Logistic regression assessed the rapid tranquilization concept with to haloperidol as parameter: midazolam Exp(B) = 0.718 (95% CI 0.362–1.421), p = 0.341, had no difference; haloperidol plus promethazine Exp(B) = 0.011 (95% CI 0.004–0.026), p < 0.001] and haloperidol plus midazolam Exp(B) = 0.019 (95% CI 0.07–0.050) p < 0.001] had higher chance to fail. Secondary outcomes are described in manuscript. Data suggest that the use of monotherapy should be encouraged, and the use of associations does not produce better results to reach rapid tranquilization over 12 h.