Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: A double-blind randomised placebo controlled trial

Hn, Vijayakumar; Ramya, K; Dr, Duggappa; Kv, Gowda; Sudheesh, K.; SS, Nethra; Rs, Raghavendra Rao

doi:10.4103/0019-5049.193664

Cited by 26 publications

(26 citation statements)

References 30 publications

(36 reference statements)

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“…The results of the present meta-analysis indicated that melatonergics were associated with a decreasing incidence of delirium in critically ill patients. Based on the encouraging results of the primary RCTs (10,12,20,22), suggesting that administration of melatonin and melatonin agonists might be a promising medication for the prevention of delirium in at-risk populations, our meta-analysis provided advanced evidence. These encouraging results were considered to be quite reasonable.…”

Section: Discussionmentioning

confidence: 99%

“…Ramelteon was administered in the other two (15,22). The subjects of six RCTs (10,13,15,(20)(21)(22) were elderly (mean age, >60 years), whereas they were apparently younger (mean age, <40 years) in the other (12). Table 1 presents the characteristics of the included studies.…”

Section: Study Characteristics and Qualitymentioning

confidence: 99%

“…The 2013 clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the ICU recommended CAM-ICU, the most valid monitoring tool so far (6). After that, the latest RCTs (12,14,15) used CAM-ICU as the assessment tool. More experience using CAM-ICU to screen delirium is needed for future studies and clinical practice.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…However, a meta-analysis including four RCTs indicated no significant difference (11). Since then, several well-designed RCTs have been conducted (12)(13)(14)(15)(16). A recent meta-analysis evaluated delirium as a subset but included only three RCTs for this result (17).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Melatonergics in Prevention of Delirium: A Systematic Review and Meta-Analysis

et al. 2020

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Background: Delirium is a commonly found comorbidity in hospitalized patients and is associated with adverse outcomes. Melatonin is an endogenous hormone that exerts multiple biological effects, mainly in regulating diurnal rhythms and in inflammatory process and immune responses. We aimed to assess the efficacy of exogenous melatonergics in the prevention of delirium. Methods: We conducted a search to identify relevant randomized controlled studies (RCTs) in PubMed, Cochrane Library, and EMBASE databases that had been published up to December 2019. Hospitalized adult patients administered melatonergics were included. The primary outcome measure was the incidence of delirium. The secondary outcome measure was the length of stay in intensive care unit (ICU-LOS). The pooled effects were analyzed as the risk ratio (RR) for delirium incidence, weighted mean difference (WMD) for ICU-LOS, and 95% confidence intervals (CIs). Results: Nine RCTs with 1,210 patients were included. The forest plots showed that melatonergics were associated with a decreasing incidence of delirium (RR, 0.51; 95% CI, 0.30-0.85; I² = 70%; p = 0.01). There was no significant difference in ICU-LOS (WMD, −0.08; 95% CI, −0.19-0.03; I² = 0; p = 0.17). Conclusion: Administration of exogenous melatonergics to hospitalized patients seems to be associated with a decreasing incidence of delirium. PROSPERO registration number: CRD42019138863.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Qualitymentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Melatonergics in Prevention of Delirium: A Systematic Review and Meta-Analysis

et al. 2020

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“…Twelve trials, [7,11,[16][17][18][19][20][21][22][23][24][25] including 2538 patients, were evaluated and eligible for the meta-analysis. The flow diagram for study inclusion is shown in Figure 1.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

Prophylactic melatonin for delirium in critically ill patients: A systematic review and meta-analysis with trial sequential analysis

Yan

Song

et al. 2022

Medicine

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Background: Up to 80% of patients in the intensive care unit (ICU) suffer from delirium. Studies on the preventative use of melatonin in the ICU have produced mixed results. We performed a systematic review and meta-analysis to evaluate whether early administration of melatonin reduces the prevalence of delirium in critically ill patients.Methods: We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing melatonin or melatonin agonists to placebo in ICU setting. The population included adult patients in the ICU. The primary outcome was the prevalence of delirium. Secondary outcomes included duration of delirium, delirium-free day, serum melatonin concentration, need for sedation, duration of mechanical ventilation, hospital and ICU length of stay (LOS), all-cause mortality, sleep quality, and adverse events. Trial sequential analysis (TSA) was performed on the primary outcome to prevent the risk of random error and multiplicity phenomenon as a result of repeated significance testing across all the included trials.Results: Twelve trials with a total of 2538 patients were analyzed. When all trials were pooled, the incidence of delirium in ICU patients who received melatonin was significantly lower than in those who received placebo (risk ratio, 0.77; 95% confidence interval: 0.61-0.96; I 2 = 56%). There were no significant differences in secondary outcomes including duration of delirium, duration of mechanical ventilation, ICU LOS, hospital LOS, and mortality. TSA indicated that Z-curve crossed the traditional boundary, but did not cross the monitoring boundary for benefit, which indicated that it is still inconclusive that melatonin affects the incidence of delirium.Conclusions: This meta-analysis found that early administration of melatonin may result in a decreased delirium prevalence in critically ill patients. However, the sensitivity analysis of high-quality studies did not support this finding. In addition, TSA demonstrated that the result may have false-positive error. Therefore, this finding should be interpreted with caution. Further studies are needed to examine the effectiveness of prophylactic melatonin on the prevalence and duration of ICU delirium in the future.

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Recent Developments in the Clinical Management of Weaponized Nerve Agent Toxicity

Barbuto

Chai

2020

21st Century Prometheus

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Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: A double-blind randomised placebo controlled trial

Cited by 26 publications

References 30 publications

Assessment of Melatonergics in Prevention of Delirium: A Systematic Review and Meta-Analysis

Assessment of Melatonergics in Prevention of Delirium: A Systematic Review and Meta-Analysis

Prophylactic melatonin for delirium in critically ill patients: A systematic review and meta-analysis with trial sequential analysis

Recent Developments in the Clinical Management of Weaponized Nerve Agent Toxicity

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