Dronabinol for agitation in the Trauma Intensive Care Unit: A retrospective pilot study

Background: Treatment of agitation in the intensive care unit is constantly evolving. Currently, antipsychotics and benzodiazepines are commonly used to treat agitation. Dronabinol is an active cannabinoid that produces psychological effects similar to tetrahydrocannabinol. Objective: The pilot study aimed to determine the efficacy of dronabinol for agitation in a Shock Trauma Intensive Care Unit (STICU) at a Tertiary Academic Medical Center in the United States. Methods: This was a single-center, retrospective observational study of adult patients receiving dronabinol for agitation in the STICU unit from January 1, 2020, to June 1, 2024. Patients were excluded if they were prisoners, received dronabinol for an indication other than agitation, or received invasive mechanical ventilation or dexmedetomidine within 48 hours before or during dronabinol initiation. The primary outcome was the difference in cumulative morphine milligram equivalents (MME) 48 hours before and after dronabinol initiation. Results: The charts of 110 patients were reviewed, and 25 patients were selected for inclusion. Patients had an average age of 42.28 ± 15.6 years. Out of 25 patients, 48% tested positive for cannabinoids, and 9% had a traumatic brain injury upon admission. The primary outcome was not statistically different between before and after dronabinol initiation (143.36 MME vs. 132.71 MME; P = 0.834). There was also no statistically significant decrease in the number of antipsychotic administrations (0.25 vs. 0.50; P = 0.497) or benzodiazepines and barbiturates (1.28 vs 0.91; P = 0.279). Conclusion: Based on the findings from our study, which included a limited number of non-intubated patients admitted to a STICU, the addition of dronabinol did not statistically decrease the cumulative MME or the need for benzodiazepines, barbiturates, or anti-psychotics. Further studies are warranted to address the effects of dronabinol in intubated patients.