by
Nishikimi, Mitsuaki; Numaguchi, Atsushi; Takahashi, Kunihiko; Miyagawa,
Yasuhiro; Matsui, Kota; Higashi, Michiko; Makishi, Go; Matsui, Shigeyuki;
Matsuda, Naoyuki /
Critical Care Medicine: July 2018 -
Volume 46 - Issue 7 - p 1099–1105
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. Interventions: The intervention group received
ramelteon (8 mg/d), and the control group received placebo (1 g/d of lactose
powder) at 20:00 hours every day until discharge from the ICU. Measurements and
Main Results: A total of 88 subjects were randomized to the ramelteon group (45
subjects) or the placebo group (43 subjects). As the primary endpoint, there
was a trend toward decrease in the duration of ICU stay (4.56 d) in the
ramelteon group compared with the placebo group (5.86 d) (p = 0.082 and p =
0.028 before and after adjustments). As the secondary endpoints, statistically
significant decreases in the occurrence rate (24.4% vs 46.5%; p = 0.044) and
duration (0.78 vs 1.40 d; p = 0.048) of delirium were observed in the ramelteon
group. The nonintubated patients of the ramelteon group showed statistically
significantly fewer awakenings per night and a higher proportion of nights
without awakenings. Conclusions: Ramelteon tended to decrease the duration of
ICU stay as well as decreased the occurrence rate and duration of delirium
statistically significantly.
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