Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation

The complete spectrum of neuropsychiatric effects SARS-CoV-2 acute respiratory distress syndrome has yet to be fully appreciated, particularly in intubated patients. Manifestations including delirium and catatonia need considered COVID-19 Medications known exhibit neuroprotective effects, like valproate, can assist agitation related sedative withdrawal during extubation. This case series reports on the management agitation, delirium, patients after extubation efforts. We present three cases which Psychiatry was consulted for These were managed severe weaning from as well subsequent psychiatric challenges, catatonia. Patient 1: 26-year-old female with bipolar I psychotic features who admitted hypoxic failure pneumonia. After an emergency C-section at 31 weeks’ gestation, she 9 days started valproate 250 mg BID agitation. She extubated successfully discharged home. 2: 42-year-old PTSD following COVID-19-related failure. received 250mg successfully. became catatonic when home quetiapine resumed recovered discontinuation lorazepam. valproic acid alprazolam. 3: 23-year-old intubated. risperidone re-initiated, but addition lorazepam, gabapentin, duloxetine. Quetiapine added before discharge. Valproate effective managing extubation, evidenced by normalizing Richmond Agitation Sedation Scale scores. Additionally, aided post-extubation. efforts sodium, due its ability manage is possibly explains successful process.