Serum melatonin concentration in critically ill patients randomized to sedation or non-sedation

Annals of Intensive Care

Jakob Oxlund¹  Thomas Strøm²  Palle Toft²  Jørgen T. Lauridsen³  Torben Knudsen⁴  Poul J. Jennum⁵ 

[1] Department of Anesthesiology and Intensive Care, Hospital of Southwest Jutland, Finsensgade 35, 6700, Esbjerg, Denmark;Department of Anesthesiology and Intensive Care, Odense University Hospital, J.B. Winsløwsvej 4, 5000, Odense, Denmark;Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark;Department of Internal Medicine, Hospital of Southwest Jutland, Finsensgade 35, 6700, Esbjerg, Denmark;Department of Neurophysiology, Danish Center of Sleep Medicine. Rigshospitalet, Valdemar Hansens vej 1 – 23, 2600, Glostrup, Denmark;

关键词: Melatonin;    Circadian;    Rhythm;    Sedation;    Non-sedation;    Delirium;   

DOI  :  10.1186/s13613-021-00829-1

来源: Springer

【 摘 要 】

BackgroundAbolished circadian rhythm is associated with altered cognitive function, delirium, and as a result increased mortality in critically ill patients, especially in those who are mechanically ventilated. The causes are multifactorial, of which changes in circadian rhythmicity may play a role. Melatonin plays a crucial role as part of the circadian and sleep/wake cycle. Whether sedation effects circadian regulation is unknown. Hence, the objective of this study was to evaluate the melatonin concentration in critically ill patients randomized to sedation or non-sedation and to investigate the correlation with delirium.MethodsAll patients were included and randomized at the intensive care unit at the hospital of southwest Jutland, Denmark. Seventy-nine patients completed the study (41 sedated and 38 non-sedated). S-melatonin was measured 3 times per day, (03.00, 14.00, and 22.00), for 4 consecutive days in total, starting on the second day upon randomization/intubation. The study was conducted as a sub-study to the NON-SEDA study in which one hundred consecutive patients were randomized to sedation or non-sedation with a daily wake-up call (50 in each arm). Primary outcome: melatonin concentration in sedated vs. non-sedated patients (analyzed using linear regression). Secondary outcome: risk of developing delirium or non-medically induced (NMI) coma in sedated vs. non-sedated patients, assessed by CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) analyzed using logistic regression.ResultsMelatonin concentration was suppressed in sedated patients compared to the non-sedated. All patients experienced an elevated peak melatonin level early on in the course of their critical illness (p = 0.01). The risk of delirium or coma (NMI) was significantly lower in the non-sedated group (OR 0.42 CI 0.27; 0.66 p < 0.0001). No significant relationship between delirium development and suppressed melatonin concentration was established in this study (OR 1.004 p = 0.29 95% CI 0.997; 1.010).ConclusionMelatonin concentration was suppressed in sedated, critically ill patients, when compared to non-sedated controls and the frequency of delirium was elevated in sedated patients.Trail registration Clinicaltrials.gov (NCT01967680) on October 23, 2013.

【 授权许可】

CC BY