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Valproic acid for agitation in the intensive care unit: an observational study of psychiatric consults

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Abstract

Background

Agitation is a common clinical problem encountered in the intensive care unit (ICU). Treatment options are based on clinical experience and sparse quality literature.

Aim

The aim of this study was to describe the effect of valproic acid (VPA) as adjuvant treatment for agitation in the ICU, identify predictors of response to VPA and evaluate the independent effect of VPA on agitation compared to standard of care (SOC).

Method

This retrospective single center observational study evaluated adult patients admitted to the ICU for whom a psychiatric consultation was requested for agitation management, with agitation defined as a Richmond Agitation Sedation Score of 2 or greater. A descriptive analysis of the proportion of agitation-free patients per day of follow-up, the incidence of agitation-related-events, as well as the evolution of co-medications use over time are presented. A logistic regression model was used to assess predictors of VPA response, defined as being agitation-free on Day 7 and generalized estimating equations were used to evaluate the independent effect of VPA as adjuvant therapy for agitation in the critically ill.

Results

One hundred seventy-five patients were included in the study with 78 receiving VPA. The percentage of agitation-free patients on VPA was 6.5% (5/77) on Day 1, 14.1% (11/78) on Day 3 and 39.5% (30/76) on Day 7. Multivariate regression model for clinical and demographic variables identified female gender as predictor of response on Day 7 (OR 6.10 [1.18–31.64], p = 0.03). The independent effect of VPA was non-significant when compared to SOC.

Conclusion

Although VPA used as adjuvant treatment was associated with a decrease in agitation, its effect when compared to SOC did not yield significant results.

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Fig. 1
Fig. 2

ARE definition: unplanned extubation; medical device removal; fall from bed; attempted escape from the ICU; removing physical restraints; self-harm; assault on medical personnel

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Acknowledgements

Maxime Roux, pharmacy intern at Aix-Marseille Université for his help in data collection.

Funding

Faculty of Pharmacy of Université de Montréal provided funding for statistical analyses.

Author information

Authors and Affiliations

  1. Department of Pharmacy, Réseau local de Gaspé, CISSS de la Gaspésie, 215 Boul York W, Gaspé, QC, G4X 2W2, Canada

    Geneviève White

  2. Department of Pharmacy, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada

    Noah Adessky, Anne Regazzoni & Marc M. Perreault

  3. Department of Pharmacy, CIUSSS Centre-Sud-de-l’île-de-Montréal, Hôpital Notre-Dame, 1560 Sherbrooke St E, Montreal, QC, H2L 4M1, Canada

    Fei-Wen Chen

  4. Department of Psychiatry, Montreal General Hospital, McGill University Health Center, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada

    Leon Tourian & Majed Alharbi

  5. Department of Mathematics and Statistic, University of Montreal, 2920 Chemin de la Tour, Montreal, QC, H3C 3J7, Canada

    Miguel Chagnon

  6. McGill University Health Centre, 1650 Cedar Ave., Montreal, QC, H3G 1A4, Canada

    Ashvini Gursahaney

  7. Department of Medicine and Critical Care, McGill University, Montreal, Canada

    Ashvini Gursahaney

  8. Department of Adult Mental Health, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia

    Majed Alharbi

  9. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

    Majed Alharbi

  10. Department of Pharmacy and Research Center, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin West, Montreal, QC, H4J 1C5, Canada

    David Williamson

  11. Faculté de Pharmacie, Université de Montréal, Pavillon Jean-Coutu, 2940 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada

    David Williamson & Marc M. Perreault

Authors
  1. Geneviève White
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  2. Noah Adessky
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  3. Fei-Wen Chen
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  4. Anne Regazzoni
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  5. Leon Tourian
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  6. Miguel Chagnon
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  7. Ashvini Gursahaney
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  8. Majed Alharbi
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  9. David Williamson
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  10. Marc M. Perreault
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Correspondence to Geneviève White.

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Cite this article

White, G., Adessky, N., Chen, FW. et al. Valproic acid for agitation in the intensive care unit: an observational study of psychiatric consults. Int J Clin Pharm 46, 177–185 (2024). https://doi.org/10.1007/s11096-023-01661-2

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  • DOI: https://doi.org/10.1007/s11096-023-01661-2

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