Effect of melatonin by nasal feeding on sleep in tracheotomised patients in ICU / 临床麻醉学杂志

ABSTRACT

Objective To discuss the effect of melatonin on sleep and agitation in patients who had undergone tracheotomy in ICU.Methods Sixty-six tracheotomisd patients of ASA Ⅱ or Ⅲ in ICU were included,age 18-60 years,weaning from mechanical ventilation not receiving continuous sedation.We conducted a double-blind, placebo-controlled randomized pilot study comparing melatonin with placebo in such patients.They were allocated into two groups by compute randomiza-tion-melatonin group(n =32)and control group(n = 34).We administered either oral melatonin (3 mg)or placebo at 20∶00 for 7 days.We collected pre-and post-dosage blood samples on days 1 and 3 to confirm drug delivery.The hours of sleep at day and night were assessed by the bedside nurse as the primary outcome.And the secondary outcome included comparison of the incidence of agitation, assessed by score on the Riker Sedation Agitation Scale,and requirement for sedatives or haloperidol to settle agitation.Results Pre-treatment melatonin levels in the two groups were similarly low.Post-treatment,melatonin levels increased significantly in the melatonin group compared with the placebo group (3 233±1 961 )pg/ml versus (3.8 ± 2.2 )pg/ml(P < 0.05 ).And subsequently the observed sleep time in the two groups was (1 1.9±2.0)hours for melatonin vs (7.8±1.6)hours for placebo, respectively (P < 0.01 ).The incidence of agitation was significantly lower in the melatonin group (0% vs 8.8%).Conclusion Melatonin is well absorbed,and a standard dose increases blood levels approximately 1000-fold.Furthermore it would help the tracheotomisd patients sleep and ease agitation in ICU.