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DeliriumPhase 3MIND-USANCT01211522

The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA (MIND-USA) Study

A Phase 3 study testing Haloperidol and Ziprasidone in people with Delirium and Impaired Cognition, run by Vanderbilt University Medical Center at 16 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The long-term objective of the MIND-USA (Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) Study is to define the role of antipsychotics in the management of delirium in vulnerable critically ill patients. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Haloperidol and Ziprasidone
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
566 participants
Where
16 sitesUnited States
Study dates
14 Dec 2011to 19 Jul 2018
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • adult patients (≥18 years old)
  • in a medical and/or surgical ICU
  • on mechanical ventilation or non-invasive positive pressure ventilation (NIPPV), and/or requiring vasopressors due to shock
  • delirious (according to the CAM-ICU)

Who cannot join

  • Rapidly resolving organ failure criteria, indicated by planned immediate discontinuation of mechanical ventilation, NIPPV, and/or vasopressors at the time of screening for study enrollment
  • Pregnancy or breastfeeding (negative pregnancy test required prior to enrollment of female patients of childbearing age)
  • Severe dementia or neurodegenerative disease, defined as either impairment that prevents the patient from living independently at baseline or IQCODE >4.5, measured using a patient's qualified surrogate, mental illness requiring long-term institutionalization, acquired or congenital mental retardation, Parkinson's disease, Huntington's disease, and/or coma or another severe deficit due to structural brain disease such as stroke, intracranial hemorrhage, cranial trauma, intracranial malignancy, anoxic brain injury, or cerebral edema.
  • History of torsades de pointes, documented baseline QT prolongation (congenital long QT syndrome), or QTc >500 ms at screening due to refractory electrolyte abnormalities, other drugs, or thyroid disease
  • Ongoing maintenance therapy with typical or atypical antipsychotics
  • History of neuroleptic malignant syndrome (NMS), haloperidol allergy, or ziprasidone allergy
  • Expected death within 24 hours of enrollment or lack of commitment to aggressive treatment by family or the medical team (e.g., likely withdrawal of life support measures within 24 hours of screening)
  • Inability to obtain informed consent from an authorized representative within 72 hours of meeting all inclusion criteria, i.e., developing qualifying organ dysfunction criteria.

Trial locations and contacts

16 sites in 1 country.

16 sites in 1 country

United States16 sites
  • University of Michigan Health System

    Ann Arbor, Michigan, 48109-5360

  • University of Maryland Medical Center

    Baltimore, Maryland, 21201

  • Massachusetts General Hospital

    Boston, Massachusetts, 02114-2696

  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

  • University of North Carolina - Chapel Hill

    Chapel Hill, North Carolina, 27599-7248

  • The Ohio State Medical Center

    Columbus, Ohio, 43210-1228

  • Baylor Health Care System

    Dallas, Texas, 75206

  • Denver Health/University of Colorado Health Sciences Center

    Denver, Colorado, 80204-4507

  • Moses Cone Health System

    Greensboro, North Carolina, 27410

  • Indiana University

    Indianapolis, Indiana, 46202-2915

  • University of Iowa

    Iowa City, Iowa, 52242

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232-8300

  • Yale University Medical Center

    New Haven, Connecticut, 06520-8057

  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104-6205

  • University of Washington

    Seattle, Washington, 98195-9472

  • Albert Einstein Medical College-Montefiore Medical Center

    The Bronx, New York, 10461

Other trials in United States

About this study

Official title: MIND-USA Study: Modifying the Impact of ICU-Associated Neurological Dysfunction

The long-term objective of the MIND-USA (Modifying the Impact of ICU-Induced Neurological Dysfunction-USA) Study is to define the role of antipsychotics in the management of delirium in vulnerable critically ill patients. We and others have shown that delirium is an independent predictor of more death, longer stay, higher cost, and long-term cognitive impairment often commensurate with moderate dementia. The rapidly expanding aging ICU population is especially vulnerable to develop delirium, with 7 of 10 medical and surgical ICU patients developing this organ dysfunction. Antipsychotics are the first-line pharmacological agents recommended to treat delirium, and over the past 30 years they gained widespread use in hospitalized patients globally prior to adequate testing of efficacy and safety for this indication. Haloperidol, the most commonly chosen antipsychotic, is used by over 80% of ICU doctors for delirium, while atypical antipsychotics are prescribed by 40%. Antipsychotics safety concerns include lethal cardiac arrhythmias, extrapyramidal symptoms, and the highly publicized increased mortality associated with their use in non-ICU geriatric populations. The overarching hypothesis is that administration of typical and atypical antipsychotics-haloperidol and ziprasidone, in this case-to critically ill patients with delirium will improve short- and long-term clinical outcomes, including days alive without acute brain dysfunction (referred to as delirium/coma-free days or DCFDs) over a 14-day period; 30-day, 90-day, and 1-year survival; ICU length of stay; incidence, severity, and/or duration of long-term neuropsychological dysfunction; and quality of life at 90-day and 1-year. To test these hypotheses, the MIND-USA Study will be a multi-center, double-blind, randomized, placebo-controlled investigation in 561 critically ill, delirious medical/surgical ICU patients who are (a) on mechanical ventilation or non-invasive positive pressure ventilation or (b) in shock on vasopressors. In each group (haloperidol, ziprasidone, and placebo), 187 patients will be enrolled and treated until delirium has resolved for 48 hours or to 14 days (whichever occurs first) and followed for 1 year.

Read the detailed description

The primary and secondary outcomes of the MIND-USA investigation will be analyzed both according to the individual comparisons by group of "haloperidol treated" vs. "placebo treated" and "ziprasidone treated" vs. "placebo treated" and also the combined grouping of both antipsychotics ("haloperidol plus ziprasidone treated" patients vs. "placebo treated" patients). In the latter third of the study, as a result of a paper by Patel S et al AJRCCM 2014 about rapidly reversible delirium (RRD), we considered modifying delirium assessments to detect those who might convert from CAM-ICU positive to negative following SATs, but we estimated that only 5 patients per arm would be in this category (and indeed <20 per arm in the entire study using the 10% rate published by Patel). With such low numbers and the assurance that through randomization we would have all groups analyzed similarly according to the study drug assignment, we elected not to alter the protocol and not to conduct subgroup analyses according to RRD status.

Being tested
Haloperidol, Ziprasidone, Placebo
Keywords
Delirium, Intensive care, Mechanical ventilation, Antipsychotic, Haloperidol, Ziprasidone, Randomized, Placebo, Sepsis, Sedation, Long-term cognitive impairment
Medical subject headings
Delirium, Cognition Disorders, Sepsis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • HaloperidolDrug

    Also called Haldol

    Haloperidol, up to 10mg q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes at concentrations of 5mg/mL. Patient will only receive IV while in the ICU.

  • ZiprasidoneDrug

    Also called Geodon

    Ziprasidone, up to 20mg q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes at concentrations of 10mg/mL. Patient will only receive IV while in the ICU.

  • PlaceboDrug

    Placebo, up to 10mL q12 hours, will be administered intravenously (IV) by bolus over up to 5 minutes. Patient will only receive IV while in the ICU.

Study groups in NCT01211522
Study groupRoleWhat they receive
HaloperidolExperimentalHaloperidol
Receives: Drug: Haloperidol
ZiprasidoneExperimentalZiprasidone
Receives: Drug: Ziprasidone
PlaceboPlacebo comparatorPlacebo
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Delirium/Coma-free Days (DCFDs)

    Defined as the number of days during the 14-day intervention period (beginning on the day of randomization) that the patient was alive and experienced neither delirium nor coma.

    Measured: 14 days

Secondary outcomes (9)
  1. Mortality

    Deaths within the specified timeframe

    Measured: 30-day and 90-day

  2. Delirium Duration

    Duration of delirium during the intervention period

    Measured: 14 days

  3. Number of Participants With Torsades de Pointes

    Measured: 14 days plus 4-day post-study drug period (if longer than 14 days)

  4. Number of Participants With Extrapyramidal Symptoms

    Measured: 14 days plus 4-day post-study drug period (if longer than 14 days)

  5. Number of Participants With Neuroleptic Malignant Syndrome

    Measured: 14 days plus 4-day post-study drug period (if longer than 14 days)

  6. Time to Liberation From Mechanical Ventilation

    Days from randomization to successful liberation from mechanical ventilation, where "successful" indicates that liberation was followed by at least 48 hours alive and without reinitiation of invasive or noninvasive ventilation.

    Measured: 30 days

  7. Time to Final ICU Discharge

    Days from randomization to final, successful ICU discharge, where "successful" indicates that discharge was followed by at least 48 hours alive. "ICU discharge" is represented by readiness for ICU discharge indicated by a physician order for transfer to a lower level of care even if a bed availability problems prevent actual discharge from the ICU.

    Measured: 90 days

  8. Time to ICU Readmission

    Days from first ICU discharge to next ICU readmission.

    Measured: 90 days after first ICU discharge

  9. Time to Hospital Discharge

    Days from randomization to successful hospital discharge, where "successful" indicates that discharge was followed by at least 48 hours alive.

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Sep 2010 (estimated)
  2. Study start14 Dec 2011
  3. Primary completion28 Aug 2017
  4. Study completion19 Jul 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
566 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01211522
Sponsor's protocol ID
AG035117-01A1
Other IDs
101082
Acronym
MIND-USA
Status last verified
Oct 2019
First submitted
28 Sep 2010
Last updated
18 Nov 2019
Data monitoring committee
Yes

Publications

  • Boehm LM, Mart MF, LaNoue M, Siao SF, Pun BT, Bowton DL, Exline MC, Gong MN, Hite RD, Hough CL, Hyzy RC, Khan BA, Owens RL, Pisani MA, Rock P, Schmidt GA, Jackson JC, Ely EW, Girard TD, Brummel NE. Association between ABCDE bundle compliance and long-term outcomes: a secondary longitudinal analysis. Intensive Care Med. 2026 Mar;52(3):466-475. doi: 10.1007/s00134-026-08346-0. Epub 2026 Feb 25.

    PubMed 41739187
  • Ahn S, LaNoue M, Su H, Moale AC, Scheunemann LP, Kiehl AL, Douglas IS, Exline MC, Gong MN, Khan BA, Owens RL, Pisani MA, Rock P, Jackson JC, Ely EW, Girard TD, Boehm LM. Post-Intensive Care Syndrome and Caregiver Burden: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2025 Apr 1;8(4):e253443. doi: 10.1001/jamanetworkopen.2025.3443.

    PubMed 40198074
  • Mart MF, Boehm LM, Kiehl AL, Gong MN, Malhotra A, Owens RL, Khan BA, Pisani MA, Schmidt GA, Hite RD, Exline MC, Carson SS, Hough CL, Rock P, Douglas IS, Feinstein DJ, Hyzy RC, Schweickert WD, Bowton DL, Masica A, Orun OM, Raman R, Pun BT, Strength C, Rolfsen ML, Pandharipande PP, Brummel NE, Hughes CG, Patel MB, Stollings JL, Ely EW, Jackson JC, Girard TD. Long-term outcomes after treatment of delirium during critical illness with antipsychotics (MIND-USA): a randomised, placebo-controlled, phase 3 trial. Lancet Respir Med. 2024 Aug;12(8):599-607. doi: 10.1016/S2213-2600(24)00077-8. Epub 2024 Apr 30.

    PubMed 38701817
  • Stollings JL, Boncyk CS, Birdrow CI, Chen W, Raman R, Gupta DK, Roden DM, Rivera EL, Maiga AW, Rakhit S, Pandharipande PP, Ely EW, Girard TD, Patel MB. Antipsychotics and the QTc Interval During Delirium in the Intensive Care Unit: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2352034. doi: 10.1001/jamanetworkopen.2023.52034.

    PubMed 38252439
  • Girard TD, Exline MC, Carson SS, Hough CL, Rock P, Gong MN, Douglas IS, Malhotra A, Owens RL, Feinstein DJ, Khan B, Pisani MA, Hyzy RC, Schmidt GA, Schweickert WD, Hite RD, Bowton DL, Masica AL, Thompson JL, Chandrasekhar R, Pun BT, Strength C, Boehm LM, Jackson JC, Pandharipande PP, Brummel NE, Hughes CG, Patel MB, Stollings JL, Bernard GR, Dittus RS, Ely EW; MIND-USA Investigators. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness. N Engl J Med. 2018 Dec 27;379(26):2506-2516. doi: 10.1056/NEJMoa1808217. Epub 2018 Oct 22.

    PubMed 30346242

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Haloperidol and Ziprasidone in people with Delirium and Impaired Cognition, run by Vanderbilt University Medical Center at 16 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Nov 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 20 Aug 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Delirium/Coma-free Days (DCFDs) (time frame: 14 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01211522, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Nov 2019.

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