Melatonin to prevent delirium in the intensive care unit
Melatonin to prevent delirium in the intensive care unit
reference
Baumgartner L, Lam K, Lai J, et al. Effectiveness of melatonin for the prevention of deliriums in the intensive care unit. pharmacotherapy . 2019; 39 (3): 280-287.
objective
to determine whether melatonin is an effective therapy for the prevention of deliriums in the intensive care unit (ICU)
draft
retrospective observing cohort study
participant
The study included 232 adults (≥ 18 years): 117 patients in the melatonin group and 115 patients in the control group. The patients were admitted to the medical or cardiological intensive care unit between 2013 and 2017, and those who were administered melatonin were compared to those who did not receive it. The exclusion criteria included the use of antipsychotics or sleeping pills before the admission, primary neurological diseases or injuries, hepatic encephalopathy, liver diseases in the final stage, active withdrawal from alcohol consumption and all diseases that prevent delir-screening.
study parameters evaluated
The development of a delirium was determined by 2 successive positive results of the Confusion Assessment Method for the ICU (cam-icu) within a period of 14 days after admission. The CAM ICU rating was administered to the participants every 12 hours.
Primary result measurements
The appearance of a delirium in the intensive care unit at patients treated with melatonin; The melaton indose used. A secondary end point were delirious days in a period of 28 days.
important knowledge
The development of an intensive darn was significantly lower in the group of participants who received melatonin therapy.
The participants of the melatonin group experienced a significantly lower delirium development rate (9 [7.7%] against 28 [24.3%]; p = 0.001).
The results remained significant if they were rated in numerous other models that checked several variables. The controls included age, gender, hypertension in the anamnesis, necessity of emergency surgery, acute physiology and chronic health assessment II score, mechanical ventilation, length of stay in the intensive care unit, dexmedetomidine intake and benzodiazepine intake.
Since most patients who develop this disease are critically ill, an ideal intervention would be a high rate of risk reduction, additional health -supporting measures and low to no side effects.
For those who developed a delirium, there was no statistical significance between the groups. The participants of the melatonin group experienced 19.9 delirious days without a coma, compared to 20.9 days in the control group ( p = 0.72).
Typical initial cans for melatonin were 3-6 mg per night and the cans were titrated at 9-10 mg depending on the need for sleep. In the patients who developed a delirium, the average dose was 3 mg, with an area of 1-5 mg.
practice implications
At the moment there is no pharmacological therapies approved by the US Food and Drug Administration (FDA) for the treatment or prevention of deliriums in the intensive care unit. Treatment is often based on antipsychotic drugs that carry their own significant risk profile; The risks of antipsychotics include further neurological impairments and the risk of death in older adults with dementia - a population that could overlap with those who are most likely to be affected by delirium in the intensive care unit. Since most patients who develop this disease are critically ill, an ideal intervention would be a high rate of risk reduction, additional health -supporting measures and few to no side effects. Melatonin corresponds to this ideal.
Although this simple and non -toxic intervention is not pursued in the current study, it can influence the overall results. The authors find that "the delirium in the intensive care unit (ICU) is an acute dysfunction of the brain, which was associated with an increased mortality rate, longer stays in the intensive care unit and in the hospital and the development of cognitive impairments after the intensive care unit." This implies that further studies with melatonin may show even more profound advantages in this patient population.
melatonin is natural therapy with many other well -supported applications and generally mild side effects. It is not entirely clear whether the usefulness of melatonin in the intensive care unit is based on its remarkable effects on the regulation of the circadian rhythm (although this is probably an active mechanism) or on another unknown mechanism. However, since sleep differences are concerned and are a plausible factor in the development of a delirium in critical patients, this is together with the proposed antioxidative, cardioprotective,
Although the study does not provide any evidence of an optimal dose, the data indicate that nightly doses of 3.5 mg or more could be beneficial.
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