In this episode, I’ll discuss whether melatonin can prevent ICU delirium.
Numerous medications have been studied in an attempt to find something that prevents the development of ICU delirium. Studies involving melatonin have produced mixed results, and a group of authors from Australia sought to determine via a high quality randomized controlled trial whether melatonin can prevent the development of ICU delirium.
The study took place over a 3 year period across 12 different ICUs in Australia. To be enrolled, patients had to have been admitted to the ICU within the past 48 hours, be at least 18 years old, and have an expected ICU stay of at least 72 hours.
A little more than 800 patients were enrolled and split between the placebo group and the treatment group which received 4 mg liquid melatonin every night at 2100 for 14 days or until discharge from the ICU.
The primary outcome was the proportion of delirium-free assessments, as a marker of delirium prevalence, within 14 days or before ICU discharge.
During the study patients were assessed twice a day with the CAM-ICU score to determine the presence of delirium.
A variety of secondary outcomes were also assessed including sleep quality and quantity, hospital and ICU LOS, and in-hospital and 90-day mortality.
The melatonin group had 79.2% of their CAM-ICU assessments negative for delirium compared with 80% for placebo. This translates to no difference between groups with a p value of 0.547. With the secondary outcomes there were also no differences between groups.
Unfortunately, it appears based on this study that melatonin 4 mg nightly has no effect on delirium or any other clinically meaningful outcome in ICU patients.
The 4 mg nightly melatonin regimen used in this trial is not the only one that has been studied for use in ICU patients, so the possibility exists that a different regimen may be proven beneficial in the future. However until more data is available, the high quality of this randomized, multi center placebo controlled trial suggests there is not a role for using melatonin to prevent ICU delirium.
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