Valproic Acid for the Management of Agitation and Delirium in the Intensive Care Setting: A Retrospective Analysis

Crowley, Kaitlin; Urben, Lindsay; Hacobian, Gaspar; Geiger, Krystina

doi:10.1016/j.clinthera.2020.02.007

Cited by 32 publications

(29 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At our institution, the most common valproic acid regimen prescribed was 250 mg 3 times daily for a total daily dose of 750 mg, which is lower than the mean daily doses of 1000 to 1500 mg/d reported in prior studies. 22-24,26 Despite using lower doses, we found no correlation between total daily dose and delirium resolution. This is similar to prior studies, although the sample sizes are likely too small to detect differences.…”

Section: Discussioncontrasting

confidence: 55%

“…This is similar to prior studies, although the sample sizes are likely too small to detect differences. 22-26 Additionally, 30% of patients in our study had valproic acid levels drawn. Although there are recommendations for target concentrations in bipolar disorder (50-125 µg/mL) and epilepsy (50-100 µg/mL), there is no guidance for goal levels when using valproic acid for agitation or delirium, and currently there is no correlation between serum concentration and delirium resolution.…”

Section: Discussionmentioning

confidence: 78%

“…These findings differ from prior literature, which has reported reductions in agitation with the use of valproic acid. 23,24,26 There is likely variability in findings between studies because of how delirium and agitation days were calculated and defined and limitations with retrospective data collection. We opted to use the validated CAM-ICU score to report incidence of delirium and the validated RASS score to report incidence of agitation because these are required nursing assessments that are documented in our electronic medical record.…”

Section: Discussionmentioning

confidence: 99%

“…These time comparisons were chosen to be similar to those in prior literature. 24,26 Both the proportion of patients receiving adjunctive medications as well as the equivalent dosages were assessed at these same time points using the Wilcoxon signed-rank test. A 2-tailed P value of less than 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

“…21 The available literature demonstrates improved control of agitation and decreased adjunctive medication use with valproic acid. 22-26 The objective of this study was to evaluate the prescribing practices of valproic acid in the ICUs at our institution for agitation and delirium and identify any associated benefits or adverse effects.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

et al. 2020

View full text Add to dashboard Cite

Background: Analgesics, sedatives, and antipsychotics are commonly prescribed for agitation and delirium in the intensive care unit (ICU), but their use is limited by adverse effects and lack of efficacy. Valproic acid is an alternative treatment option. Objective: The primary objective of this study was to describe valproic acid prescribing in our institution’s ICUs when used for agitation or delirium. Measures of effectiveness and safety were also assessed. Methods: This was a single-center, retrospective, institutional review board–approved cohort study of adult inpatients admitted to the ICU between January 2018 and August 2018. Patients who received valproic acid for the treatment of agitation or delirium for ≥24 hours were included. Prescribing practices were evaluated for dose, frequency, and route of administration. Effectiveness was assessed via agitation and delirium assessment tools and quantity of adjunctive agents used. Results: A total of 80 patients were included, with 35 receiving valproic acid alone and 45 in conjunction with antipsychotics. The most common valproic acid regimen was 250 mg orally 3 times daily. Delirium resolution occurred in 55% of patients: 24 in the valproic acid monotherapy group and 20 in the valproic acid plus antipsychotic group (69% vs 44%; P = 0.03). The incidence of delirium decreased from valproic acid day 0 to day 3 (93% vs 68%; P < 0.01), with no change in agitation (64% vs 63%; P = 0.28). Conclusion and Relevance: Valproic acid is frequently prescribed in agitated, delirious patients at our institution and may have a role in the management of ICU delirium.

show abstract

Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

et al. 2020

View full text Add to dashboard Cite

show abstract

Drug Treatment of Other Psychiatric Conditions

2021

The Maudsley Prescribing Guidelines in Psychiatry

View full text Add to dashboard Cite

Borderline personality disorder (BPD) is common in psychiatric settings, affecting 20% of community psychiatric patients. Common co‐morbid conditions affecting patients with BPD include affective disorders anxiety spectrum disorders, eating disorders, and drug and alcohol misuse, and the lifetime risk of having at least one co‐morbid mental disorder approaches 100%. Although classified as a personality disorder, several aspects of BPD have been assumed to be responsive to drug treatment. Drug treatments are often used during periods of crisis when symptoms can be severe, distressing and potentially life‐threatening. Psychiatric conditions often coexist with eating disorders, and this may in part explain the benefit sometimes seen with medication. Drugs have limited activity in anorexia nervosa, and none is currently licensed for this condition. Delirium is a common neuropsychiatric condition that presents in medical and surgical settings and is known by various names including organic brain syndrome, intensive care psychosis and acute confusional state.

show abstract

Part II: Case series: Acute agitation, delirium, and sleep management

Smith

2024

J Am Coll Clin Pharm

View full text Add to dashboard Cite

LEARNING OBJECTIVES1. Apply bedside clinical assessment tools to detect pain, agitation, and delirium in the critically ill patient.2. Design an evidence-based pharmacotherapy regimen for agitation in the critically ill patient.3. Evaluate pharmacologic approaches for prevention and management of ICU delirium.4. Assess therapeutic approaches to improve sleep quality in critically ill patients. 5. Develop a population-based approach for agitation, delirium, and sleep disturbance management in the ICU.

show abstract

Valproic Acid for the Management of Agitation and Delirium in the Intensive Care Setting: A Retrospective Analysis

Cited by 32 publications

References 22 publications

Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

Prescribing Practices of Valproic Acid for Agitation and Delirium in the Intensive Care Unit

Drug Treatment of Other Psychiatric Conditions

Part II: Case series: Acute agitation, delirium, and sleep management

Contact Info

Product

Resources

About