(952) Evaluation of Valproate for the Treatment of Acute Agitation in Critically Ill Patients

Introduction: Agitation and delirium commonly affect patients in the critical care setting, leading to worse outcomes and longer hospital length of stay. The Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the Intensive Care Unit (ICU) Guidelines recognize that the use of valproate and derivatives have shown efficacy in small studies for reducing agitation and delirium but should continue to be further evaluated. This study aims to assess the efficacy of valproate in comparison to antipsychotic agents (including haloperidol, quetiapine, olanzapine, and ziprasidone) for managing agitation in critically ill patients.

Methods: This retrospective chart review included patients admitted to University Hospitals Cleveland Medical Center (UH CMC) from January 1st, 2021, to August 31st, 2023. Patients aged 18 to 89 were included if admitted to an intensive care unit at UH CMC, received one of the study agents for agitation, and received the study agent for at least 2 consecutive days. Patients were excluded if study agents were initiated before admission, for reasons other than agitation, or as part of hospice care. The primary outcome was the change in agitation level, measured as the mean Richmond Agitation-Sedation Scale (RASS) score 24 hours prior to medication administration, compared to the mean RASS score 48 hours after medication administration. Secondary outcomes included the addition or removal of antipsychotic medications, benzodiazepines, and/or dexmedetomidine within 48 hours of study medication initiation, time within the goal RASS score, and prescribing practices of valproate when used for agitation.

Results: Sixty patients met inclusion criteria, with 30 patients each in the valproate and antipsychotics groups. The change in average RASS score from baseline to 48 hours post-medication administration was similar between both groups +0.09 in the valproate group versus +0.39 in the antipsychotics group; (p = 0.376). Secondary outcomes were similar among both groups.

Conclusions: Valproate demonstrated similar efficacy and safety compared to antipsychotic agents in managing acute agitation in critically ill patients.