(942) Evaluation of Melatonin Versus Ramelteon for Delirium Prevention

Introduction: Delirium is associated with poor outcomes in hospitalized patients including longer hospital length of stay (LOS) stay and increased mortality. Current Pain, Agitation/Sedation, Delirium, Immobility, and Sleep disruption (PADIS) guidelines do not have medication recommendations for ICU delirium prevention, though some studies suggest that ramelteon and melatonin may decrease ICU LOS and delirium incidence. No literature compares the use of melatonin and ramelteon to prevent ICU delirium. This study evaluated the difference between melatonin and ramelteon in preventing incidence of ICU delirium.

Methods: A retrospective cohort study was conducted within an integrated healthcare system using electronic medical records. Adult patients >18 years prescribed ramelteon or melatonin for >2 consecutive doses admitted to an ICU over a 2-year period were included. Patients were excluded for ICU LOS < 48 hours, taking melatonin or ramelteon prior to admission, lack of CAM-ICU documentation or positive CAM-ICU prior to initiation of study drugs, incarceration or pregnancy. The primary outcome was incidence of ICU delirium. Key secondary outcomes included duration of delirium and ICU LOS. Wilcoxon rank sum test was used for non-parametric continuous variables and Fisher’s exact test was used for categorical variables.

Results: A random sample of 70 patients were assessed. Baseline data was comparable between groups. Median doses were melatonin 9 mg (3-9 mg) and ramelteon 8 mg. Incidence of delirium occurred more frequently in the melatonin group compared to the ramelteon group 8 [20.5%] vs 1 [3.2%]; p=0.038). Median duration of delirium was longer in the melatonin group (3.44 days vs 1.5 days [1.04-11.17 days]). The median ICU LOS was comparable between groups (4.78 days [8.04 - 3.15] vs 5.18 days [9.78 - 3.4]; p=0.391).

Conclusions: The results of this study suggest incidence and duration of ICU delirium may be greater in ICU patients receiving melatonin versus ramelteon. However, there was no significant difference found in ICU LOS. Further studies are needed to confirm these results.