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Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*

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-c...

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Autores principales: Nishikimi, Mitsuaki, Numaguchi, Atsushi, Takahashi, Kunihiko, Miyagawa, Yasuhiro, Matsui, Kota, Higashi, Michiko, Makishi, Go, Matsui, Shigeyuki, Matsuda, Naoyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6012040/
https://www.ncbi.nlm.nih.gov/pubmed/29595562
http://dx.doi.org/10.1097/CCM.0000000000003132
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author Nishikimi, Mitsuaki
Numaguchi, Atsushi
Takahashi, Kunihiko
Miyagawa, Yasuhiro
Matsui, Kota
Higashi, Michiko
Makishi, Go
Matsui, Shigeyuki
Matsuda, Naoyuki
author_facet Nishikimi, Mitsuaki
Numaguchi, Atsushi
Takahashi, Kunihiko
Miyagawa, Yasuhiro
Matsui, Kota
Higashi, Michiko
Makishi, Go
Matsui, Shigeyuki
Matsuda, Naoyuki
author_sort Nishikimi, Mitsuaki
collection PubMed
description 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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spelling pubmed-60120402018-07-03 Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial* Nishikimi, Mitsuaki Numaguchi, Atsushi Takahashi, Kunihiko Miyagawa, Yasuhiro Matsui, Kota Higashi, Michiko Makishi, Go Matsui, Shigeyuki Matsuda, Naoyuki Crit Care Med Clinical Investigations 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. Lippincott Williams & Wilkins 2018-07 2018-06-15 /pmc/articles/PMC6012040/ /pubmed/29595562 http://dx.doi.org/10.1097/CCM.0000000000003132 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Clinical Investigations
Nishikimi, Mitsuaki
Numaguchi, Atsushi
Takahashi, Kunihiko
Miyagawa, Yasuhiro
Matsui, Kota
Higashi, Michiko
Makishi, Go
Matsui, Shigeyuki
Matsuda, Naoyuki
Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title_full Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title_fullStr Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title_full_unstemmed Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title_short Effect of Administration of Ramelteon, a Melatonin Receptor Agonist, on the Duration of Stay in the ICU: A Single-Center Randomized Placebo-Controlled Trial*
title_sort effect of administration of ramelteon, a melatonin receptor agonist, on the duration of stay in the icu: a single-center randomized placebo-controlled trial*
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6012040/
https://www.ncbi.nlm.nih.gov/pubmed/29595562
http://dx.doi.org/10.1097/CCM.0000000000003132
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