Valproate for agitation in critically ill patients: A retrospective study

Area of Science:

• Critical Care Medicine
• Neuroscience
• Pharmacology

Background:

• Agitation and delirium are common and serious complications in critically ill patients.
• Current management strategies for these conditions often involve multiple psychoactive medications with potential side effects.

Purpose of the Study:

• To evaluate the efficacy and safety of valproate therapy for managing agitation in critically ill patients.
• To assess the relationship between valproate use and the incidence of agitation and delirium.

Main Methods:

• A retrospective cohort study of critically ill adults treated with valproate for agitation.
• Data collected on prescribing practices, safety, and incidence of agitation and delirium.
• Comparison of outcomes between day 1 and day 3 of valproate therapy; mixed models used for analysis.

Main Results:

• Valproate therapy significantly decreased the incidence of agitation (96% to 61%) and delirium (68% to 49%) by day 3.
• Concomitant use of opioids and dexmedetomidine also decreased.
• Valproate was associated with reduced use of fentanyl and lorazepam equivalents.

Conclusions:

• Valproate therapy demonstrated a significant reduction in agitation and delirium within 48 hours of initiation.
• The treatment was associated with decreased use of other psychoactive medications.
• Common adverse effects included hyperammonemia and thrombocytopenia.