Abdul Kazi
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Disclosure information not submitted.
Eleni Florakis, BS
Medical Student
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Lydia Huang, BS
Medical Student
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Jade Phillips, BA
Medical Student
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Gabrielle Dunsky, PharmD
Pharmacist
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Cara McDaniel, PharmD, BCPS, BCCCP,
Advanced Clinical Pharmacy Specialist, Critical Care
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Erika Yoo, MD
Associate Professor
Thomas Jefferson University Hospital, United States
Disclosure information not submitted.
Title: Impact of Melatonin on Sedative Infusion Requirements in COVID-19-Associated Respiratory Failure
INTRODUCTION/HYPOTHESIS:
COVID-19 induced respiratory failure results in a high percentage of ICU patients requiring prolonged mechanical ventilation, often with high sedation requirements. Melatonin supplementation may reduce sedative doses and duration in non-COVID patients. We sought to determine if enteral melatonin administration was associated with decreased sedative infusion requirements for mechanically ventilated COVID-19 patients.
Methods:
We performed a retrospective analysis of intubated, sedated, and non-paralyzed ICU patients with acute hypoxic respiratory failure secondary to PCR-confirmed COVID-19 pneumonia who received melatonin for at least three days during intravenous sedative infusion from March 1 to August 31, 2020. The weight-based doses of selected sedatives (hydromorphone, midazolam, and dexmedetomidine) and bolus requirements were recorded. Sedative requirements on days following nightly melatonin administration (melatonin days) were compared to requirements on days following no nightly melatonin administration (non-melatonin days) using paired-sampled t- test. Study was approved by the local institutional review board (# 20E.1159).
Results:
Out of 180 ventilated COVID patients, 36 were administered melatonin (20%), and 17 were given melatonin for at least 3 days. There was no difference in the dose of hydromorphone infusion (1.00 mg/hr vs 1.48 mg/hr;, p =0.31), average number of daily boluses (2.9 vs 2.2; p = 0.40), or average bolus doses (0.66 mg vs 0.69 mg; p=0.88) infused on melatonin vs non-melatonin days. There was no difference in the dose of midazolam infusion (3.8 mg/kg/hr vs 2.9 mg/kg/hr; p= 0.29) and average midazolam bolus dose (1.2 mg vs 0.9mg; p=0.14) on melatonin vs non-melatonin days. Melatonin was associated with an increase in the average number of daily midazolam boluses administered 3.3 vs 1.0;p=0.03). There was no difference in the dose of dexmedetomidine infusion on melatonin vs non-melatonin days (0.9 mcg/kg/hr vs 0.9 mcg/kg/hr;p=.094).
Conclusions:
Our data suggest that in mechanically ventilated COVID-19 patients, the administration of melatonin does not affect sedative infusion or bolus dosage requirements for commonly used ICU sedatives.