Lindsey Branstetter, BCCCP, PharmD
Emergency Medicine Clinical Specialist
Emory Healthcare
Atlanta, Georgia
Disclosure information not submitted.
Jolie Gallagher, PharmD, BCCCP
Critical Care Pharmacist
Northside Hospital Gwinnett, United States
Disclosure information not submitted.
Kayla Lawlor, BCCCP, BS, PharmD
Clinical Pharmacy Specialist, Cardiovascular Surgical ICU
Emory University Hospital
Atlanta, Georgia
Disclosure information not submitted.
Subir Goyal, PhD
Biostatistician Senior
Winship Cancer Institute, United States
Disclosure information not submitted.
Ayesha Mukhtar, MD, MPH
Data Analyst III
Emory University Hospital, United States
Disclosure information not submitted.
Title: Evaluation of the Use of Modafinil in Critically Ill Patients: A Retrospective Chart Review
INTRODUCTION/HYPOTHESIS: Modafinil (Provigil®) is an FDA approved tablet to promote wakefulness in patients with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Delirium has been associated with increased duration of ventilation, hospital length of stay, and mortality in critically ill patients. Current knowledge about modafinil to promote wakefulness and impact delirium in critically ill patients is sparse. The aim of this study was to investigate the impact of modafinil on delirium and associated outcomes in the critically ill population.
Methods: This was a retrospective chart review conducted among Intensive Care Units (ICUs) within an academic medical center. Included patients were at least 18 years old, had an ICU stay for at least 48 hours, and were Confusion Assessment Method for the ICU (CAM-ICU) positive for at least one time during the stay. Exclusion criteria include use of modafinil, benzodiazepine, or antipsychotic use at home, lowest Glasgow Coma Score (GCS) ≥ 13 within 48 hours before study inclusion, history of neurologic impairment, sleep disorders, or psychiatric conditions, and neuroscience admission.
Patients receiving modafinil were matched 1:2 to patients without the receipt of modafinil with 54 patients in the modafinil group and 27 control. Patients were matched based on admitting ICU, Sequential Organ Failure Assessment (SOFA) score, and age. The primary outcome of this study was the difference in duration of delirium.
Results: The primary outcome of this study was the difference in duration of delirium, with a median of 5 days in the modafinil group and 3 days in the control group (p=0.04). Hospital LOS and duration of mechanical ventilation were statistically significant between the groups, with the modafinil group experiencing both a longer hospital LOS and duration of mechanical ventilation. Richmond agitation-sedation scale (RASS), GCS, reintubation rates, in-hospital mortality, ability to participate in PT/OT, and rates of non-pharmacologic delirium interventions performed between the groups were not different between the groups.
Conclusion: Critically ill patients who received modafinil had a significantly increased duration of delirium compared to control, as well as an increased hospital LOS and mechanical ventilation duration.