Prophylactic Melatonin for Delirium in Intensive Care Unit: An Updated Systematic Review and Meta-analysis of...

Area of Science:

• Critical Care Medicine
• Pharmacology
• Intensive Care Unit (ICU) Management

Background:

• Delirium is prevalent in critically ill patients, with incidence rates of 45-83% in the ICU.
• Previous trials suggested melatonin and melatonergic agents may reduce delirium incidence.

Purpose of the Study:

• To evaluate the efficacy of prophylactic melatonin in reducing delirium incidence and severity.
• To assess melatonin's impact on ICU/hospital length of stay, mechanical ventilation, and ICU mortality.

Main Methods:

• A systematic search identified randomized controlled trials comparing melatonin with placebo or standard care.
• Data synthesis was performed using Review Manager (RevMan 5.4), reporting results as mean differences or risk ratios.

Main Results:

• The meta-analysis of 12 studies found no significant reduction in delirium incidence (OR 0.63; p=0.22) or severity (MD 0.22; p=0.78).
• Melatonin did not significantly affect ICU LOS (MD 0.05; p=0.89), hospital LOS (MD -1.46; p=0.35), or need for mechanical ventilation (OR 0.74; p=0.37).
• A significant reduction was observed in the duration of mechanical ventilation (MD -0.85; p=0.03).

Conclusions:

• Prophylactic melatonin does not appear to significantly reduce delirium incidence, severity, ICU/hospital LOS, or ICU mortality.
• Further research is warranted to clarify the role of melatonin in ICU delirium management.
• A significant decrease in mechanical ventilation duration was noted, suggesting a potential benefit in this specific outcome.