Effects of administration of melatonin on agitation and duration of stay in patients of traumatic brain injury admitted to neurosurgical intensive care unit –A retrospective study
Keywords:
Neurosurgery; Intensive care unit; Agitation; Length of stay; MelatoninAbstract
Background: Agitation is frequently encountered in patients recovering from traumatic brain injury in intensive care unit .The etiopathology for agitation is multifactorial. Melatonin has been widely used to study the effects of delirium in intensive care unit, however its effect on agitation are not well studied.
Objectives: To assess the effect of melatonin administration on the prevalence of agitation and length of stay in patients with severe traumatic brain injury, managed conservatively or undergoing decompressive craniectomy.
Study design: A retrospective observational study.
Participants: 70 patients undergoing various decompressive craniotomy or managed conservatively, and admitted to NSICU were included in the study. 36 patients were recruited from the control group and 34 patients received melatonin during their stay in the intensive care unit.
Methods: In this study, records of 70 patients who had suffered isolated traumatic brain injury with no associated injuries were analysed. The patients had a Glasgow coma score of 3-14 on admission to intensive care unit. The patients were managed as per the standard protocols, as per the existing guidelines, based on traumatic brain injury guidelines.
Results: A non-significant decreasing trend of agitation and reduced duration of ICU stay was noted in patients who received melatonin compared with the control group. The prevalence of agitation observed on modified Ramsay scale (Mean±SD) in patients who received melatonin on Day 3, Day 4 , Day 5, Day 6 , Day 7 , Day 8, Day 9 were -1.67 ± 3.01;-1.61 ± 2.82;-1.2 ± 2.55;-1.23 ± 2.51; -1.23 ± 2.11;-1.05 ± 2.09 and 0.76 ±2.03 respectively. These scores were slightly lower than observed in the control group on Day 3, Day 4 , Day 5, Day 6 , Day 7 , Day 8, Day 9 as -1.58 ± 3.16;-1.33 ± 2.72;-1.08 ± 2.46;-1.13 ± 2.25; -0.94 ± 1.87;-0.52 ± 1.7 and 0.52 ±1.36 respectively. The mean± SD duration of stay in intensive care unit of patients receiving melatonin (13.14 ±3.37) and not receiving melatonin (14.52±3.73) was comparable (p value = 0.1.)
Conclusions: Though there was a decreased prevalence of agitation and a decrease in mean duration of the ICU stay in patients who received oral melatonin, these beneficial effects did not show any statistical significance once compared with the control group.
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