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delirium, melatonin, critically patient

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https://www.readbyqxmd.com/read/29595562/effect-of-administration-of-ramelteon-a-melatonin-receptor-agonist-on-the-duration-of-stay-in-the-icu-a-single-center-randomized-placebo-controlled-trial
#1
Mitsuaki Nishikimi, Atsushi Numaguchi, Kunihiko Takahashi, Yasuhiro Miyagawa, Kota Matsui, Michiko Higashi, Go Makishi, Shigeyuki Matsui, Naoyuki Matsuda
OBJECTIVES: Occurrence of delirium in the ICU is associated with a longer stay in the ICU. To examine whether the use of ramelteon, a melatonin agonist, can prevent delirium and shorten the duration of ICU stay of critically ill patients. DESIGN: A single-center, triple-blinded, randomized placebo-controlled trial. SETTING: ICU of an academic hospital. PATIENTS: Eligible patients were ICU patients who could take medicines orally or through a nasogastric tube during the first 48 hours of admission...
July 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29184454/sleep-quality-and-circadian-rhythm-disruption-in-the-intensive-care-unit-a-review
#2
REVIEW
Yuliya Boyko, Poul Jennum, Palle Toft
Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group...
2017: Nature and Science of Sleep
https://www.readbyqxmd.com/read/28363933/feasibility-of-melatonin-for-prevention-of-delirium-in-critically-ill-patients-a-protocol-for-a-multicentre-randomised-placebo-controlled-study
#3
RANDOMIZED CONTROLLED TRIAL
Lisa Burry, Damon Scales, David Williamson, Jennifer Foster, Sangeeta Mehta, Melanie Guenette, Eddy Fan, Michael Detsky, Azar Azad, Francis Bernard, Louise Rose
INTRODUCTION: Delirium is highly prevalent in the intensive care unit (ICU) and is associated with adverse clinical outcomes. At this time, there is no drug that effectively prevents delirium in critically ill patients. Alterations in melatonin secretion and metabolism may contribute to the development of delirium. Administration of exogenous melatonin has been shown to prevent delirium in non-critically ill surgical and medical patients. This trial will demonstrate the feasibility of a planned multicentre, randomised controlled trial to test the hypothesis that melatonin can prevent delirium in critically ill patients compared with placebo...
March 30, 2017: BMJ Open
https://www.readbyqxmd.com/read/28061873/prophylactic-melatonin-for-delirium-in-intensive-care-pro-medic-study-protocol-for-a-randomised-controlled-trial
#4
RANDOMIZED CONTROLLED TRIAL
F Eduardo Martinez, Matthew Anstey, Andrew Ford, Brigit Roberts, Miranda Hardie, Robert Palmer, Lynn Choo, David Hillman, Michael Hensley, Erin Kelty, Kevin Murray, Bhajan Singh, Bradley Wibrow
BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium...
January 6, 2017: Trials
https://www.readbyqxmd.com/read/27881185/melatonin-and-melatonin-agonists-to-prevent-and-treat-delirium-in-critical-illness-a-systematic-review-protocol
#5
REVIEW
Jennifer Foster, Lisa D Burry, Lehana Thabane, Karen Choong, Kusum Menon, Mark Duffett, Alexandra Cheung, Melanie Guenette, Timothy Chimunda, Louise Rose
BACKGROUND: Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA) have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes...
November 24, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/26805535/-study-of-prevention-and-control-of-delirium-in-ventilated-patients-by-simulating-blockage-of-circadian-rhythm-with-sedative-in-intensive-care-unit
#6
RANDOMIZED CONTROLLED TRIAL
Junyan Li, Chenming Dong, Hong Zhang, Hongsong Zhang, Ruixia Song, Zhaohui Yang, Fang Feng, Yan Qi, Jing Yang
OBJECTIVE: To explore the effect of giving sedatives according to the circadian rhythm in prevention of occurrence of delirium and the prognosis of patients undergoing mechanical ventilation in intensive care unit (ICU). METHODS: A prospective double-blinded randomized controlled trial (RCT) was conducted. The patients admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University from July 2014 to February 2015, undergoing invasive mechanical ventilation over 12 hours were enrolled...
January 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/26308428/circadian-rhythm-disruption-in-the-critically-ill-an-opportunity-for-improving-outcomes
#7
REVIEW
Mark A Oldham, Hochang B Lee, Paul H Desan
OBJECTIVES: Circadian rhythms are severely disrupted among the critically ill. These circadian arrhythmias impair mentation, immunity, autonomic function, endocrine activity, hormonal signaling, and ultimately healing. In this review, we present a modern model of circadian disruption among the critically ill, discuss causes of these circadian arrhythmias, review observational and intervention studies of the effects of circadian-rhythm-restoring factors on medical outcomes, and identify needed key trials of circadian interventions in the critically ill...
January 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26144941/disruption-of-circadian-rhythms-and-delirium-sleep-impairment-and-sepsis-in-critically-ill-patients-potential-therapeutic-implications-for-increased-light-dark-contrast-and-melatonin-therapy-in-an-icu-environment
#8
REVIEW
Carlos J Madrid-Navarro, Rosa Sanchez-Galvez, Antonio Martinez-Nicolas, Ros Marina, Jose A Garcia, Juan A Madrid, Maria A Rol
The confinement of critically ill patients in intensive care units (ICU) imposes environmental constancy throughout both day and night (continuous light, noise, caring activities medications, etc.), which has a negative impact on human health by inducing a new syndrome known as circadian misalignment, circadian disruption or chronodisruption (CD). This syndrome contributes to poor sleep quality and delirium, and may impair septic states frequently observed in critically ill patients. However, and although the bidirectional crosstalk between CD with sleep impairment, delirium and inflammation in animal models has been known for years and has been suspected in ICU patients, few changes have been introduced in the environment and management of ICU patients to improve their circadian rhythmicity...
2015: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/25135124/impact-of-oral-melatonin-on-critically-ill-adult-patients-with-icu-sleep-deprivation-study-protocol-for-a-randomized-controlled-trial
#9
RANDOMIZED CONTROLLED TRIAL
Huawei Huang, Li Jiang, Ling Shen, Guobin Zhang, Bo Zhu, Jiajia Cheng, Xiuming Xi
BACKGROUND: Sleep deprivation is common in critically ill patients in intensive care units (ICU). It can result in delirium, difficulty weaning, repeated nosocomial infections, prolonged ICU length of stay and increased ICU mortality. Melatonin, a physiological sleep regulator, is well known to benefit sleep quality in certain people, but evidence for the effectiveness in ICU sleep disturbance is limited. METHODS/DESIGN: This study has a prospective, randomized, double-blind, controlled, parallel-group design...
August 18, 2014: Trials
https://www.readbyqxmd.com/read/23551983/enteral-vs-intravenous-icu-sedation-management-study-protocol-for-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Giovanni Mistraletti, Elena S Mantovani, Paolo Cadringher, Barbara Cerri, Davide Corbella, Michele Umbrello, Stefania Anania, Elisa Andrighi, Serena Barello, Alessandra Di Carlo, Federica Martinetti, Paolo Formenti, Paolo Spanu, Gaetano Iapichino
BACKGROUND: A relevant innovation about sedation of long-term Intensive Care Unit (ICU) patients is the 'conscious target': patients should be awake even during the critical phases of illness. Enteral sedative administration is nowadays unusual, even though the gastrointestinal tract works soon after ICU admission. The enteral approach cannot produce deep sedation; however, it is as adequate as the intravenous one, if the target is to keep patients awake and adapted to the environment, and has fewer side effects and lower costs...
April 3, 2013: Trials
https://www.readbyqxmd.com/read/23312124/perioperative-plasma-melatonin-concentration-in-postoperative-critically-ill-patients-its-association-with-delirium
#11
Shiho Yoshitaka, Moritoki Egi, Hiroshi Morimatsu, Tomoyuki Kanazawa, Yuichiro Toda, Kiyoshi Morita
PURPOSE: Delirium is a common complication in postoperative critically ill patients. Although abnormal melatonin metabolism is thought to be one of the mechanisms of delirium, there have been few studies in which the association between alteration of perioperative plasma melatonin concentration and postoperative delirium was assessed. MATERIALS: We conducted a prospective observational study to assess the association of perioperative alteration of plasma melatonin concentration with delirium in 40 postoperative patients who required intensive care for more than 48 hours...
June 2013: Journal of Critical Care
https://www.readbyqxmd.com/read/22620020/-delirium-insomnia-in-hospitalization-and-ramelteon
#12
COMPARATIVE STUDY
Takao Ito
Ramelteon acts on a highly selective melatonin (MT1/MT2) receptor agonist. During delirium in postoperative and critically ill patients, a disruption of the sleep-wake cycle is frequently observed. Melatonin has a key role in the regulation of the sleep-wake cycle, so this raised the hypothesis that alterations in the metabolism of melatonin might play an important role in the development of delirium. Ramelteon and exogenous melatonin may have a prophylactic treatment for frail older persons at high risk for delirium that is safe, effective, and easily implementable in daily practice...
May 2012: Nihon Rinsho. Japanese Journal of Clinical Medicine
https://www.readbyqxmd.com/read/22419624/potential-use-of-melatonin-in-sleep-and-delirium-in-the-critically-ill
#13
REVIEW
J Bellapart, R Boots
Intensive care delirium is a well-recognized complication in critically ill patients. Delirium is an independent risk factor for death in the intensive care unit (ICU), leading to oversedation, increased duration of mechanical ventilation, and increased length of stay. Although there has not been a direct causal relationship shown between sleep deprivation and delirium, many studies have demonstrated that critically ill patients have an altered sleep pattern, abnormal levels of melatonin, and loss of circadian rhythms...
April 2012: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/22404330/sleep-disturbances-in-critically-ill-patients-in-icu-how-much-do-we-know
#14
REVIEW
Y Boyko, H Ording, P Jennum
Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns in critically ill patients including abnormal circadian rhythm, high arousal and awakening index, reduced Slow Wave Sleep, and Rapid Eye Movement sleep. The purpose of this study is to summarise different aspects of sleep-awake disturbances, causes and handling methods in critically ill patients by reviewing the underlying literature...
September 2012: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/18500209/sleep-and-delirium-in-the-intensive-care-unit
#15
REVIEW
G Mistraletti, E Carloni, M Cigada, E Zambrelli, M Taverna, G Sabbatini, M Umbrello, G Elia, A L L Destrebecq, G Iapichino
Intensive Care Unit (ICU) patients almost uniformly suffer from sleep disruption. Even though the role of sleep disturbances is not still adequately understood, they may be related to metabolic, immune, neurological and respiratory dysfunction and could worsen the quality of life after discharge. A harsh ICU environment, underlying disease, mechanical ventilation, pain and drugs are the main reasons that underlie sleep disruption in the critically ill. Polysomnography is the gold standard in evaluating sleep, but it is not feasible in clinical practice; therefore, other objective (bispectral index score [BIS] and actigraphy) and subjective (nurse and patient assessment) methods have been proposed, but their adequacy in ICU patients is not clear...
June 2008: Minerva Anestesiologica
https://www.readbyqxmd.com/read/16477412/melatonin-possible-implications-for-the-postoperative-and-critically-ill-patient
#16
REVIEW
Richard S Bourne, Gary H Mills
There is increasing interest in the hormone melatonin in postoperative and critically ill patients. The roles of melatonin in the regulation of the sleep-wake cycle, resetting of circadian rhythm disturbances and its extensive antioxidant activity have potential applications in these patient groups. The interaction between melatonin and the stresses of surgery and critical illness are explored in the context of circadian rhythms, sleep disorders and delirium. The antioxidant activity is discussed in terms of the reduction of ischaemic reperfusion injury, prevention of multi-organ failure and treatment of sepsis...
March 2006: Intensive Care Medicine
https://www.readbyqxmd.com/read/16435158/sleep-in-acute-care-units
#17
REVIEW
Ahmed BaHammam
Patients in the acute care units (ACU) are usually critically ill, making them more susceptible to the unfavorable atmosphere in the hospital. One of these unfavorable factors is sleep disruption and deprivation. Many factors may affect sleep in the ACU, including therapeutic interventions, diagnostic procedures, medications, the underlying disease process, and noise generated in the ACU environment. Many detrimental physiological effects can occur secondary to noise and sleep deprivation, including cardiovascular stimulation, increased gastric secretion, pituitary and adrenal stimulation, suppression of the immune system and wound healing, and possible contribution to delirium...
March 2006: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/16015108/metabolic-and-endocrine-effects-of-sedative-agents
#18
REVIEW
Giovanni Mistraletti, Francesco Donatelli, Franco Carli
PURPOSE OF REVIEW: To bring to the attention of the clinician the metabolic effects of most common sedatives and analgesics used in critically ill patients. RECENT FINDINGS: Most patients admitted to the intensive care unit require sedation and analgesia to reduce anxiety, agitation, and delirium and provide pain relief. Inappropriate sedation and analgesia techniques can cause harm to the already compromised patient if they do not take into account the metabolic effect they produce...
August 2005: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/15196098/abolished-circadian-rhythm-of-melatonin-secretion-in-sedated-and-artificially-ventilated-intensive-care-patients
#19
K Olofsson, C Alling, D Lundberg, C Malmros
BACKGROUND: Sleep disturbance is common in intensive care patients. Aside from its unpleasantness, there is a correlation with intensive care unit (ICU) syndrome/delirium. Reasons for sleep deprivation appear to be multifactorial, including the underlying illness, an acute superimposed disturbance, medications, and the ICU environment itself. There are reasons to believe that alterations of the 'biological clock' might contribute. Melatonin secretion is one reflection of this internal sleep/wake mechanism...
July 2004: Acta Anaesthesiologica Scandinavica
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