(1712) Dronabinol for Agitation in the Trauma ICU: A Pilot Study

Introduction: Treatment of agitation in the ICU is constantly evolving. Currently, antipsychotics and benzodiazepines are commonly used to treat hyperactive delirium or agitation. Dronabinol is an active cannabinoid which produces psychological effects similar to marijuana. There are no studies addressing the use of dronabinol for agitation in critically ill patients. The purpose of this pilot study is to determine the efficacy of dronabinol for agitation in a surgical/trauma intensive care unit.

Methods: This was a single-center, retrospective chart review of adult patients receiving dronabinol for agitation in the shock trauma ICU (STICU) from January 1, 2020 to June 1, 2024. Patients were excluded if they were a prisoner, received dronabinol for an indication other than agitation, or received invasive mechanical ventilation or dexmedetomidine within 48 hours before or during dronabinol initiation (excluding intubation in an OR setting). The primary outcome was difference in cumulative in morphine milligram equivalents (MME) 48 hours before and after dronabinol initiation.

Results: The charts of 110 patients were reviewed and 25 patients were included. Patients had an average age of 42.28 years. Out of 25 includes patients, 48% tested positive for cannabinoids and 9% had a traumatic brain injury (TBI) upon admission. On average, patients received 7.64 days of dronabinol with a cumulative dose of 58.78 mg. Prior to dronabinol initiation, 20% of patients had a RASS > 0, compared with 8% after initiation. No patients were overly sedated with a RASS < -1 after initation. The primary outcome was not statistically different between before and after dronabinol initiation (143.36 MME vs. 132.71 MME, p=0.834). There was also no statistical decrease in number of antipsychotic administrations (0.25 vs. 0.50, p=0.497) or benzodiazepines and barbiturates (1.28 vs 0.91 p=0.279). When examining the patients with a positive cannabinoid UDS, there was no difference in outcomes.

Conclusions: In non-intubated patients admitted to the STICU, the addition of dronabinol does not decrease cumulative MMEs or need for benzodiazepines, barbiturates, or antipsychotics. However, it does not appear to cause excessive sedation. Larger studies including patients on dexmedetomidine or who are mechanically intubated are warranted.