(1269) Evaluating Incidence of Agitation and Delirium in Patients on an Esmolol Infusion

Introduction: Esmolol is an infusion commonly used for treatment of abdominal aortic aneurysm, aortic dissection, hypertensive emergency, and arrhythmias. Many anecdotal reports from nurses at UW Medicine have observed that patients receiving high doses of esmolol for greater than 12 hours experience agitation and delirium. Currently, no studies have been conducted that look at the association between esmolol infusions and the development of agitation and delirium. The purpose of this study is to determine the incidence of agitation and delirium in patients on an esmolol infusion and define risk factors associated with agitation and delirium in patients on an esmolol infusion.

Methods: We conducted a retrospective, descriptive study and evaluated all adult patients at UW Medical Center and Harborview Medical Center who received an esmolol infusion for at least 12 hours between April 2021 and August 2023. Investigators collected pertinent data related to the use of esmolol and CAM-ICU scores were evaluated to identify signs of agitation and delirium. The data were analyzed using descriptive statistics and the Mann-Whitney U test to determine the incidence and potential risk factors for agitation and delirium in patients on an esmolol infusion.

Results: 100 patients were included in the trial. Positive CAM-ICU scores were reported in 23% (n=23) of patients while they were on esmolol. Patients with positive CAM-ICU scores had a slightly longer time on esmolol infusion than those with negative CAM-ICU scores (32.8 hr vs 29.0 hr), although the difference was not significant (p=0.47). The cumulative dose was also slightly higher in the positive CAM-ICU group than the negative CAM-ICU group (141.9 mg/kg vs 125.9 mg/kg), but the difference was also not significant (p=0.34). The time spent with SBP < 90 mmHg and median percentage increase in serum creatinine was similar between both groups.

Conclusions: This study demonstrates an incidence of 23% of delirium in patients on esmolol infusions for at least 12 hours in patients in the ICU. Time spent on the esmolol infusion and cumulative esmolol dose were not found to be risk factors for the development of delirium in these patients. More data is needed to fully assess if esmolol is a contributing factor for the development of delirium in patients in the ICU.