In this episode, I’ll discuss the SCCM’s updated guidelines on pain, agitation, delirium, immobility, and sleep and the new recommendation regarding melatonin.
The 2018 SCCM guidelines on pain, agitation, delirium, immobility, and sleep have received a focused update which has been published in the journal Critical Care Medicine.
One of the changes this update focused on was the evidence supporting melatonin to promote sleep in ICU patients. The 2018 guidelines state:
We make no recommendation regarding the use of melatonin to improve sleep in critically ill adults
However, since 2018, there has been additional research published in this area. The guideline authors identified 30 randomized controlled trials representing nearly 4000 ICU patients that examined the effects of melatonin in this patient population. The authors were able to pool results from 15 trials together to determine that melatonin use may reduce the prevalence of delirium in ICU patients. In addition, 3 RCTs were pooled together to determine that melatonin improved patients’ perceptions of sleep quality while in the ICU.
This data was judged to have a low certainty of providing these positive effects, however there is also a low risk of adverse events from melatonin use in ICU patients. When taken together, the balance of a possible benefit and unlikelihood of any negative effects led the guideline authors to issue a new, conditional recommendation in favor of melatonin as follows:
We suggest administering melatonin over no melatonin in adult patients admitted to the ICU
Unfortunately, the available data regarding melatonin in ICU patients had significant heterogeneity in terms of dose, duration, and frequency. This prevented the guideline authors from providing a specific recommendations for what melatonin regimen to use.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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