Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

Dianatkhah, Mehrnoush; Najafi, Atabak; Sharifzadeh, Mohammad; Ahmadi, Arezoo; Sharifnia, Hamidreza; Mojtahedzadeh, Mojtaba; Najmeddin, Farhad; Moghaddas, Azadeh

doi:10.4103/jrpp.jrpp_17_49

Cited by 19 publications

(8 citation statements)

References 29 publications

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“…The effectiveness of exogenous melatonin for the treatment of sleep disturbance [ 13 ], as antioxidant [ 14 ], antianxiety agent like benzodiazepine action has been established in many studies [ 13 , 15 , 16 ]. Furthermore, different from the conventional sedative agents, this hormone does not deteriorate nighttime hypoxemia or ventilator responses [ 17 – 19 ]. Besides, it has been shown that melatonin can treat and avoid ICU delirium [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Melatonin is a neuroprotective agent with sedative, hypnotic, and analgesic properties and without any respiratory depressant effect which makes it a suitable adjuvant for sedation in the ICU [ 17 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…In Dianatkhah et al’s study, the duration of mechanical ventilation and length of ICU stay were shorter in patients who received melatonin in comparison with the control group, but this difference was statistically not significant for the length of ICU stay and marginally significant for the duration of mechanical ventilation ( P = 0.065) [ 17 ]. In our study, as shown in Table 3 , the duration of mechanical ventilation was shorter in patients given melatonin vs. the control group that was in line with the Frisk, Dessap, and Dianatkhah studies.…”

Section: Discussionmentioning

confidence: 99%

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The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Soltani

Salari

Javaherforooshzadeh

et al. 2020

Eur J Trauma Emerg Surg

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Purpose This study aimed to determine the effect of exogenous melatonin on the number of sedative drugs and the duration of mechanical ventilation in traumatic intracranial hemorrhage patients in ICU. Methods This double-blind randomized clinical trial study was conducted in the ICU wards of Golestan Hospital, Ahvaz, Iran, from September 2017 to March 2018. In this study, 52 patients with intracerebral hemorrhage were selected by convenient sampling (26 patients in each group) and were randomly assigned to two groups of melatonin and control. Sedation and pain management package was applied to both groups. Outcomes: Amount of the sedative and opioid drug; mechanical ventilation time; ICU staying time; Glasgow Coma Score; hemodynamic parameters. Results There was no significant difference between them in terms of demographic characteristics. Cumulative doses of morphine and mechanical ventilation time were significant in two groups. ( P < 0.05) The mean length of ICU staying was not significant. Glasgow Coma Score on the 6th day was significant in two groups ( P < 0.05). Diastolic blood pressure was significant between groups ( P < 0.001). Conclusion This study presented that morphine consumption and mechanical ventilation time were significantly lower in the melatonin group than in the control. Also, rise in GCS in the melatonin group was faster in the melatonin group than in the control. The use of melatonin can be recommended for patients with ICH in the ICU for better outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Soltani

Salari

Javaherforooshzadeh

et al. 2020

Eur J Trauma Emerg Surg

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“…Dianatkhah et al reported a decreased length of ICU stay, length of MV and mortality in 40 intubated hemorrhagic stroke patients treated with high-dose melatonin (30mg). ( 26 ) However, these large doses have not been studied extensively and are currently not deemed safe. These results were not reproduced in further larger RCTs, such as Abbasi et al, Gandolfi et al or our study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

Bandyopadhyay,

Yaddanapudi,

Saini

et al. 2024

Crit. Care Sci.

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Objective: To determine whether enteral melatonin decreases the incidence of delirium in critically ill adults. Methods: In this randomized controlled trial, adults were admitted to the intensive care unit and received either usual standard care alone (Control Group) or in combination with 3mg of enteral melatonin once a day at 9 PM (Melatonin Group). Concealment of allocation was done by serially numbered opaque sealed envelopes. The intensivist assessing delirium and the investigator performing the data analysis were blinded to the group allocation. The primary outcome was the incidence of delirium within 24 hours of the intensive care unit stay. The secondary outcomes were the incidence of delirium on Days 3 and 7, intensive care unit mortality, length of intensive care unit stay, duration of mechanical ventilation and Glasgow outcome score (at discharge). Results: We included 108 patients in the final analysis, with 54 patients in each group. At 24 hours of intensive care unit stay, there was no difference in the incidence of delirium between Melatonin and Control Groups (29.6 versus 46.2%; RR = 0.6; 95%CI 0.38 - 1.05; p = 0.11). No secondary outcome showed a statistically significant difference. Conclusion: Enteral melatonin 3mg is not more effective at decreasing the incidence of delirium than standard care is in critically ill adults.

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“…Moreover, melatonin alleviates circadian disturbances and improves sleep, increasing delta power and decreasing sleep fragmentation in rats after an induced stroke [ 166 ]. In clinical settings, melatonin supplementation was associated with a lower risk of post-stroke delirium (a single dose of 2 mg/day at 20:00 within the first 24 h of ischemic stroke onset) compared to the control group [ 167 ] and with the shorter duration of mechanical ventilation and length of stay in the intensive care unit in a cohort of patients with hemorrhagic stroke (30 mg melatonin every night during a stay at the intensive care unit) [ 168 ]. In early and late rehabilitation periods, melatonin administration (3 mg daily for 3 months) led to an increase in the BDNF level that correlated with improved sleep, emotional status, and quality of life [ 169 , 170 ].…”

Section: Circadian System and Treatment Developments In Strokementioning

confidence: 99%

Circadian Factors in Stroke: A Clinician’s Perspective

Korostovtseva

Коломейчук

2023

Cardiol Ther

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Stroke remains one of the leading causes of mortality and long-term and permanent disability worldwide despite technological innovations and developments in pharmacotherapy. In the last few decades, the growing data have evidenced the role of the circadian system in brain vulnerability to damage, the development and evolution of stroke, and short-term and long-term recovery. On the other hand, the stroke itself can affect the circadian system via direct injury of specific brain structures involved in circadian regulation (i.e., hypothalamus, retinohypothalamic tracts, etc.) and impairment of endogenous regulatory mechanisms, metabolic derangement, and a neurogenic inflammatory response in acute stroke. Moreover, the disruption of circadian rhythms can occur or exacerbate as a result of exogenous factors related to hospitalization itself, the conditions in the intensive care unit and the ward (light, noise, etc.), medication (sedatives and hypnotics), and loss of external factors entraining the circadian rhythms. In the acute phase of stroke, patients demonstrate abnormal circadian variations in circadian biomarkers (melatonin, cortisol), core body temperature, and rest–activity patterns. The approaches aimed at the restoration of disrupted circadian patterns include pharmacological (melatonin supplementation) and non-medication (bright light therapy, shifting feeding schedules, etc.) interventions; however, their effects on short- and long-term recovery after stroke are not well understood.

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Melatonin supplementation may improve the outcome of patients with hemorrhagic stroke in the intensive care unit

Cited by 19 publications

References 29 publications

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

The effect of melatonin on reduction in the need for sedative agents and duration of mechanical ventilation in traumatic intracranial hemorrhage patients: a randomized controlled trial

Efficacy of melatonin in decreasing the incidence of delirium in critically ill adults: a randomized controlled trial

Circadian Factors in Stroke: A Clinician’s Perspective

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