Katarzyna Lewandowska1, Marta A Małkiewicz2, Mariusz Siemiński3, Wiesław J Cubała4, Paweł J Winklewski5, Wioletta A Mędrzycka-Dąbrowska6. 1. Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland. 2. Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland. 3. Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland. 4. Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland. 5. Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Slupsk, Poland. 6. Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland. Electronic address: wioletta.medrzycka-dabrowska@gumed.edu.pl.
Abstract
AIM: The intensive care unit (ICU) environment contributes to the development of sleep disturbances. Sleep disturbances, sleep fragmentation, and multiple awakening episodes lead to the circadian rhythm disorder, which increases the risk of delirium. Melatonin and melatonin receptor agonist is widely used agent in the therapy of sleep disturbances. However, there is also some for its efficacy in ICU delirium. Enteral melatonin and ramelteon supplementation eliminates (partially) the delirium inducing factors. METHODS: PubMed/MEDLINE, OVID, Embase, Cochrane Library, and Web of Science databases were searched using adequate key words. We reviewed the literature on the role of melatonin and ramelteon in the prevention of sleep disturbances and delirium in intensive care units and analysed the methods of melatonin therapy in an ICU setting. Review followed the PRISMA statement. A review written protocol was not drafted. RESULTS: Originally 380 studies were searched in five scientific databases. After rejecting the duplicate results, 125 results were obtained. Finally, 10 scientific studies were included in the review. In selected articles, the leading topics analysed were the role of melatonin and ramelteon in the prevention of delirium and sleep disorders. In addition, the noted effect of therapy with these agents on reducing the ventilation time of mechanical time and the demand for psychoactive substances in the ICU environment. CONCLUSION: Reduction of either the incidence or the severity of delirium course is possible by eliminating its risk factors. Risk factors are directly related to sleep disorders. To reduce the problem, therefore, a holistic approach to the source is necessary. The efficacy of melatonin therapy in an ICU setting requires confirmation in studies including a greater number of participants as the impact of melatonin on these factors is yet to be fully elucidated. However, the prognosis is predictive because this concept provides patients with a minimally invasive and natural form of therapy.
AIM: The intensive care unit (ICU) environment contributes to the development of sleep disturbances. Sleep disturbances, sleep fragmentation, and multiple awakening episodes lead to the circadian rhythm disorder, which increases the risk of delirium. Melatonin and melatonin receptor agonist is widely used agent in the therapy of sleep disturbances. However, there is also some for its efficacy in ICU delirium. Enteral melatonin and ramelteon supplementation eliminates (partially) the delirium inducing factors. METHODS: PubMed/MEDLINE, OVID, Embase, Cochrane Library, and Web of Science databases were searched using adequate key words. We reviewed the literature on the role of melatonin and ramelteon in the prevention of sleep disturbances and delirium in intensive care units and analysed the methods of melatonin therapy in an ICU setting. Review followed the PRISMA statement. A review written protocol was not drafted. RESULTS: Originally 380 studies were searched in five scientific databases. After rejecting the duplicate results, 125 results were obtained. Finally, 10 scientific studies were included in the review. In selected articles, the leading topics analysed were the role of melatonin and ramelteon in the prevention of delirium and sleep disorders. In addition, the noted effect of therapy with these agents on reducing the ventilation time of mechanical time and the demand for psychoactive substances in the ICU environment. CONCLUSION: Reduction of either the incidence or the severity of delirium course is possible by eliminating its risk factors. Risk factors are directly related to sleep disorders. To reduce the problem, therefore, a holistic approach to the source is necessary. The efficacy of melatonin therapy in an ICU setting requires confirmation in studies including a greater number of participants as the impact of melatonin on these factors is yet to be fully elucidated. However, the prognosis is predictive because this concept provides patients with a minimally invasive and natural form of therapy.
Authors: Laura Palagini; Raffaele Manni; Eugenio Aguglia; Mario Amore; Roberto Brugnoli; Stéphanie Bioulac; Patrice Bourgin; Jean-Arthur Micoulaud Franchi; Paolo Girardi; Luigi Grassi; Régis Lopez; Claudio Mencacci; Giuseppe Plazzi; Julia Maruani; Antonino Minervino; Pierre Philip; Sylvie Royant Parola; Isabelle Poirot; Lino Nobili; Giovanni Biggio; Carmen M Schroder; Pierre A Geoffroy Journal: Front Psychiatry Date: 2021-06-10 Impact factor: 4.157