Valproic Acid for Hyperactive Delirium and Agitation in Critically Ill Patients

Area of Science:

• Critical Care Medicine
• Neuropharmacology
• Clinical Pharmacy

Background:

• Delirium and agitation are prevalent complications in critically ill patients within intensive care units (ICUs).
• Valproic acid (VPA) has demonstrated potential benefits for ICU-associated delirium and agitation, necessitating further investigation.

Purpose of the Study:

• To assess the efficacy and safety of Valproic acid (VPA) in managing hyperactive delirium and agitation among adult patients in the ICU.

Main Methods:

• A retrospective cohort study analyzed data from critically ill patients treated with VPA for hyperactive delirium or agitation between October 2017 and October 2022.
• The primary effectiveness measure was the reduction in concomitant psychoactive medications by day 3 of VPA treatment.
• Secondary outcomes included changes in medication doses and the incidence of adverse events.

Main Results:

• A significant 33% reduction in the total number of psychoactive medications was observed by day 3 of VPA treatment (P < .001).
• VPA decreased the requirement for sedatives (midazolam equivalents) but did not significantly alter the use of dexmedetomidine, opioids, or antipsychotics.
• A 10 mg/kg loading dose of VPA reduced the risk of initiating additional psychoactive medications by day 3 (OR 2.8, P = .047), with benefits seen within 48 hours.
• Adverse events were infrequent, occurring in only 10.3% of the cohort.

Conclusions:

• The addition of Valproic acid (VPA) to existing pharmacologic regimens is safe for treating hyperactive delirium and agitation in critically ill patients.
• VPA can aid in preventing polypharmacy and reducing the overall workload associated with managing these conditions in the ICU.
• The findings are particularly relevant for patients with cardiogenic shock and respiratory failure requiring mechanical ventilation.