.jpg "Traci Grucz, PharmD, BCCCP photo")
Traci Grucz, PharmD, BCCCP
Critical Care Clinical Pharmacy Specialist
Johns Hopkins Hospital
Baltimore, MD
Disclosure information not submitted.
Christina Marengo, PharmD
PGY2 Oncology Pharmacy Resident
The Johns Hopkins Hospital, United States
Disclosure information not submitted.
David Sugrue, BCCCP, PharmD
Clinical Pharmacy Specialist, Surgical Intensive Care
n/a
Baltimore
Disclosure information not submitted.
Andrew Jarrell, PharmD, BCCCP
Clinical Pharmacist
Oregon Health & Science University, United States
Disclosure information not submitted.
Jessica Crow, PharmD, BCCCP, BCPS-AQ Cardiology, CNSC, FCCM
Clinical Pharmacy Manager
Johns Hopkins Bayview Medical Center
Baltimore, Maryland, United States
Disclosure information not submitted.
Pedro Mendez-Tellez, MD
Professory, Anesthesiology and Critical Care Medicine and Surgery
The Johns Hopkins Hospital, United States
Disclosure information not submitted.
Title: Evaluation of delirium incidence among critically ill patients receiving melatonin
Introduction: Melatonin may have utility in reducing intensive care unit (ICU) delirium. The purpose of this study was to compare delirium in critically ill patients who received melatonin compared to those who did not.
Methods: This retrospective, single health-system study included adult patients with an ICU length of stay greater than 72 hours and documented Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessment. Delirium and related clinical outcomes were compared in patients who received melatonin in the ICU versus those who did not.
Results: Of 9,796 patients included, 1,902 (19.4%) patients received melatonin at a median (IQR) dose of 3 (3-6) mg for a median (IQR) duration of 2 (1-5) days. Nine hundred (80.3%) patients received melatonin after at least one day of delirium. Patients who received melatonin had a higher incidence of delirium versus those who did not (59% vs. 53%, p < 0.001). However, melatonin use was not associated with delirium after controlling for other delirium risk factors using multivariable logistic regression (OR 0.99, 95% CI 0.87-1.12). Patients who received melatonin had a longer median (IQR) delirium duration [3 (2-9) vs. 3 (2-6) days, p < 0.001] as well as longer median (IQR) ICU (8 vs. 5 days, p < 0.001) and hospital (16 vs. 12 days, p < 0.001) lengths of stay. Continuous infusion sedative use (29.3% vs 28.1%, p=0.058) and in-hospital mortality (23% vs. 24%, p=0.87) did not differ between groups.
Conclusions: After controlling for differences in baseline characteristics and delirium risk factors, melatonin use was not associated with delirium in adult ICU patients, the majority of whom received melatonin after delirium onset.