Is there a role for melatonin in the intensive care unit?

Richards, Guy A.; Bentley, Alison; Gopalan, Dean; Brannigan, L; Paruk, Fathima

doi:10.7196/sajcc.2021.v37i2.490

Cited by 3 publications

(3 citation statements)

References 58 publications

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“…In experimental and clinical situations, melatonin reduces multiple organ failure and the death of animals and humans [103,104]. The protective actions of melatonin against MODS are a result of its multiple anti-inflammatory and antioxidant properties [105].…”

Section: Reducing Oxidative Stress and Preserving Organ Functionmentioning

confidence: 99%

The Multiple Functions of Melatonin: Applications in the Military Setting

Gancitano

Reíter

2022

Biomedicines

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The aim of this review is to provide the reader with a general overview on the rationale for the use of melatonin by military personnel. This is a technique that is being increasingly employed to manage growing psycho-physical loads. In this context, melatonin, a pleotropic and regulatory molecule, has a potential preventive and therapeutic role in maintaining the operational efficiency of military personnel. In battlefield conditions in particular, the time to treatment after an injury is often a major issue since the injured may not have immediate access to medical care. Any drug that would help to stabilize a wounded individual, especially if it can be immediately administered (e.g., per os) and has a very high safety profile over a large range of doses (as melatonin does) would be an important asset to reduce morbidity and mortality. Melatonin may also play a role in the oscillatory synchronization of the neuro–cardio–respiratory systems and, through its epigenetic action, poses the possibility of restoring the main oscillatory waves of the cardiovascular system, such as the Mayer wave and RSA (respiratory sinus arrhythmia), which, in physiological conditions, result in the oscillation of the heartbeat in synchrony with the breath. In the future, this could be a very promising field of investigation.

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Section: Reducing Oxidative Stress and Preserving Organ Functionmentioning

confidence: 99%

The Multiple Functions of Melatonin: Applications in the Military Setting

Gancitano

Reíter

2022

Biomedicines

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“…These strategies have shown promise in preclinical and clinical studies. Melatonin is a key hormone produced by the pineal gland, which regulates circadian gating of sleep (87,88). Melatonin also acts as a powerful antioxidant, due to its electron-rich aromatic indole ring (89).…”

Section: Strategies To Reverse the Detrimental Effects Of Sleep Inter...mentioning

confidence: 99%

“…Melatonin also acts as a powerful antioxidant, due to its electron-rich aromatic indole ring (89). Melatonergics used in the clinical setting include melatonin itself and ramelteon, a melatonin receptor agonist; these have been tested as a potential therapy for ICU patients and were shown to improve patients' sleep in a number of studies (16,88,(90)(91)(92)(93)(94)(95)(96). A recent meta-analysis found that melatonergics significantly decreased delirium in hospitalized patients; however, there was no significant difference in ICU length of stay (97).…”

Section: Strategies To Reverse the Detrimental Effects Of Sleep Inter...mentioning

confidence: 99%

Goodnight, Sleep Tight, Don’t Let the Microbes Bite: A Review of Sleep and Its Effects on Sepsis and Inflammation

Walker¹

2022

Shock

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Sleep is a restorative biological process that is crucial for health and homeostasis. However, patient sleep is frequently interrupted in the hospital environment, particularly within the intensive care unit. Suboptimal sleep may alter the immune response and make patients more vulnerable to infection and sepsis. In addition, hospitalized patients with sepsis experience altered sleep relative to patients without infectious disease, suggesting a bidirectional interplay. Preclinical studies have generated complementary findings, and together, these studies have expanded our mechanistic understanding. This review article summarizes clinical and preclinical studies describing how sleep affects inflammation and the host’s susceptibility to infection. We also highlight potential strategies to reverse the detrimental effects of sleep interruption in the intensive care unit.

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Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review

Singh,

Nguyen,

Kuschner

2024

J Intensive Care Med

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Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.

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Is there a role for melatonin in the intensive care unit?

Cited by 3 publications

References 58 publications

The Multiple Functions of Melatonin: Applications in the Military Setting

The Multiple Functions of Melatonin: Applications in the Military Setting

Goodnight, Sleep Tight, Don’t Let the Microbes Bite: A Review of Sleep and Its Effects on Sepsis and Inflammation

Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review

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