OBJECTIVES: To determine whether the postoperative administration of tryptophan would be beneficial for elderly adults undergoing surgery who are at risk of developing postoperative delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Denver Veterans Affairs Medical Center. PARTICIPANTS: Individuals aged 60 and older undergoing major elective operations requiring a postoperative intensive care unit (ICU) admission (n = 325). INTERVENTION: L-tryptophan, 1 g orally three times a day or placebo was started after surgery and continued for up to 3 days postoperatively. MEASUREMENTS: Delirium and its motor subtypes were measured using the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) and the Richmond Agitation and Sedation Scale. The primary outcome for between-group comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. RESULTS: The overall incidence of postoperative delirium was 39% (95% confidence interval = 34-44%) (n = 116). Seventeen percent of participants in the tryptophan group and 9% in the placebo group had excitatory delirium (P = .18), and the duration of excitatory delirium was 3.3 ± 1.7 days for tryptophan and 3.1 ± 1.9 days for placebo (P = .74). Forty percent of participants in the tryptophan group and 37% in the placebo group had overall delirium (P = .60), and the duration of overall delirium was 2.9 ± 1.8 days for tryptophan and 2.4 ± 1.6 days for placebo (P = .17). CONCLUSION:Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative ICU admission did not reduce the incidence or duration of postoperative excitatory delirium or overall delirium.
RCT Entities:
OBJECTIVES: To determine whether the postoperative administration of tryptophan would be beneficial for elderly adults undergoing surgery who are at risk of developing postoperative delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Denver Veterans Affairs Medical Center. PARTICIPANTS: Individuals aged 60 and older undergoing major elective operations requiring a postoperative intensive care unit (ICU) admission (n = 325). INTERVENTION: L-tryptophan, 1 g orally three times a day or placebo was started after surgery and continued for up to 3 days postoperatively. MEASUREMENTS: Delirium and its motor subtypes were measured using the Confusion Assessment Method-Intensive Care Unit (CAM-ICU) and the Richmond Agitation and Sedation Scale. The primary outcome for between-group comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. RESULTS: The overall incidence of postoperative delirium was 39% (95% confidence interval = 34-44%) (n = 116). Seventeen percent of participants in the tryptophan group and 9% in the placebo group had excitatory delirium (P = .18), and the duration of excitatory delirium was 3.3 ± 1.7 days for tryptophan and 3.1 ± 1.9 days for placebo (P = .74). Forty percent of participants in the tryptophan group and 37% in the placebo group had overall delirium (P = .60), and the duration of overall delirium was 2.9 ± 1.8 days for tryptophan and 2.4 ± 1.6 days for placebo (P = .17). CONCLUSION: Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative ICU admission did not reduce the incidence or duration of postoperative excitatory delirium or overall delirium.
Authors: E W Ely; S K Inouye; G R Bernard; S Gordon; J Francis; L May; B Truman; T Speroff; S Gautam; R Margolin; R P Hart; R Dittus Journal: JAMA Date: 2001-12-05 Impact factor: 56.272
Authors: Thomas N Robinson; Daniel S Wu; Lauren Pointer; Christina L Dunn; Joseph C Cleveland; Marc Moss Journal: Am J Surg Date: 2013-07-20 Impact factor: 2.565
Authors: Philip S Wang; Sebastian Schneeweiss; Jerry Avorn; Michael A Fischer; Helen Mogun; Daniel H Solomon; M Alan Brookhart Journal: N Engl J Med Date: 2005-12-01 Impact factor: 91.245
Authors: Teresa S Jones; Christina L Dunn; Daniel S Wu; Joseph C Cleveland; Deidre Kile; Thomas N Robinson Journal: JAMA Surg Date: 2013-12 Impact factor: 14.766
Authors: Christopher G Hughes; Christina S Boncyk; Deborah J Culley; Lee A Fleisher; Jacqueline M Leung; David L McDonagh; Tong J Gan; Matthew D McEvoy; Timothy E Miller Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Elizabeth Mahanna-Gabrielli; Katie J Schenning; Lars I Eriksson; Jeffrey N Browndyke; Clinton B Wright; Deborah J Culley; Lis Evered; David A Scott; Nae Yah Wang; Charles H Brown; Esther Oh; Patrick Purdon; Sharon Inouye; Miles Berger; Robert A Whittington; Catherine C Price; Stacie Deiner Journal: Br J Anaesth Date: 2019-08-19 Impact factor: 9.166
Authors: Jean-Louis Vincent; Yahya Shehabi; Timothy S Walsh; Pratik P Pandharipande; Jonathan A Ball; Peter Spronk; Dan Longrois; Thomas Strøm; Giorgio Conti; Georg-Christian Funk; Rafael Badenes; Jean Mantz; Claudia Spies; Jukka Takala Journal: Intensive Care Med Date: 2016-04-13 Impact factor: 17.440