Montefiore Medical Center, Bronx, NY, USA.
Cleveland Clinic, Cleveland, OH, USA.
Ann Pharmacother. 2021 Mar;55(3):311-317. doi: 10.1177/1060028020947173. Epub 2020 Aug 4.
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.
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.
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.
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%; = 0.03). The incidence of delirium decreased from valproic acid day 0 to day 3 (93% vs 68%; < 0.01), with no change in agitation (64% vs 63%; = 0.28).
Valproic acid is frequently prescribed in agitated, delirious patients at our institution and may have a role in the management of ICU delirium.
在重症监护病房（ICU）中，常为治疗激越和谵妄开具镇痛剂、镇静剂和抗精神病药，但这些药物的使用受到不良反应和疗效有限的限制。丙戊酸是一种替代治疗选择。
本研究的主要目的是描述我们机构 ICU 中丙戊酸用于治疗激越和谵妄时的使用情况。还评估了有效性和安全性措施。
这是一项单中心、回顾性、机构审查委员会批准的队列研究，纳入了 2018 年 1 月至 2018 年 8 月期间入住 ICU 的成年住院患者。纳入接受丙戊酸治疗激越或谵妄时间≥24 小时的患者。评估剂量、频率和给药途径的处方实践。通过激越和谵妄评估工具以及辅助药物的使用量来评估有效性。
共纳入 80 例患者，其中 35 例单独接受丙戊酸治疗，45 例联合抗精神病药治疗。最常见的丙戊酸方案为口服 250mg，每日 3 次。55%的患者出现谵妄缓解：丙戊酸单药治疗组 24 例，丙戊酸联合抗精神病药组 20 例（69%比 44%； = 0.03）。丙戊酸治疗第 0 天至第 3 天的谵妄发生率降低（93%比 68%； < 0.01），激越无变化（64%比 63%； = 0.28）。
本机构在激越和谵妄患者中经常开具丙戊酸，并且在 ICU 谵妄的治疗中可能发挥作用。
