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941: MELATONIN FOR THE PREVENTION OF INTENSIVE CARE UNIT (ICU) DELIRIUM

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Intensive care unit (ICU) delirium is an acute brain injury that has been associated with increased mortality, prolonged ICU and hospital length of stay, and development of post-ICU cognitive impairment. Despite the lack of sufficient evidence, anti-psychotics are commonly used in clinical practice to prevent and treat delirium, but pose a risk of significant adverse effects. Melatonin may serve as a natural source to restore sleep and reduce the incidence of ICU delirium. Methods: A retrospective cohort study that examined adult ICU patients from 20132017 at a large academic medical center. Patients were included in the treatment group if they received melatonin for ≥ 48 hours for the prevention of ICU delirium. Patients were included in the control group if they were admitted to the ICU for > 4 days (average time of melatonin initiation) and did not receive melatonin during their length of stay. Primary outcome assessed was incidence of delirium, assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Results: 232 patients were included in this study, with 117 patients receiving melatonin for ≥ 48 hours. There were no differences in baseline demographics between groups. The incidence of delirium was significantly reduced in the melatonin group (7.7% vs. 24%, p = < 0.001). This finding remained significant on multivariate logistic regression analysis, controlling for age, gender, history of hypertension, need for emergent surgery, APACHE II score, mechanical ventilation, ICU length of stay, and dexmedetomidine, benzodiazepine, and antipsychotic use. For those patients who developed delirium, time spent in delirium was 20.9 days in the control group vs. 19.9 days in the melatonin group (p = 0.72). Melatonin was used for 6.3 ± 7.9 days, with a median dose of 3 mg nightly (range 1–10 mg). Conclusions: This is the only study to date that has examined the efficacy of melatonin for the prevention of ICU delirium. Melatonin may be a promising agent for the prevention of ICU delirium, however prospective data is needed to further validate its efficacy.