(1023) Evaluation of Melatonin Use in Patients With Hyperactive Delirium in Surgical Intensive Care Unit

Introduction: Delirium characterized by sudden brain and cognitive dysfunction impacts nearly 80% of intensive care unit (ICU) patients, leading to distress, increased mortality and prolonged ventilator use. No pharmacological agents have shown to effectively treat hyperactive delirium. Some studies suggest prophylactic melatonin may reduce hyperactive delirium incidence but evidence of melatonin's effectiveness as a treatment option remains unclear. This study aims to assess melatonin's role in treating hyperactive delirium in surgical intensive care unit (SICU) patients across NYU Langone Health as a quality improvement initiative.

Methods: This retrospective cohort study analyzed melatonin's effect on SICU hyperactive delirium at three NYU Langone Hospital campuses over 36 months, from September 2020 to September 2023. It compared hyperactive delirium-free days in patients treated with melatonin and other anti-delirium medications versus those treated only with other anti-delirium drugs. Inclusion criteria were adults ≥18 years admitted to SICU with consistent CAM-ICU documentation, expected stay ≥72 hours, GCS >8, and no prior hyperactive delirium or mood changes.

Results: The study included 249 patients (108 in melatonin and 141 in non-melatonin) After adjusting for all covariates, the median percent hyperactive delirium-free days was 15.1% higher for patients who received melatonin than those who did not (p-value < 0.001). Additionally, melatonin group had lower duration of benzodiazepines versus the non-melatonin group (1.0 day vs 2.0 days; p< 0.001). Surgical ICU mortality was also lower in the melatonin group compared to non-melatonin group (2.8% vs 19%; p< 0.001)

Conclusions: Based on the findings, the use of melatonin appears to significantly improve outcomes of delirium in the surgical intensive care unit.