Uso de melatonina como adjuvante ao regime de analgossedação em pacientes na unidade de terapia intensiva

Abstract

Poor sleep quality is consistently reported by patients in the intensive care unit (ICU). Melatonin has been studied in several fields of action, it evidencing to be effective in improving duration and quality of sleep and a potential analgesic effect, without side effects. Therefore, it proving to be very promising therapy for patients with sleep disorders and chronic pain. Objectives: To assess whether the use of Melatonin in ICU patients has an effect on sleep; decreases the incidence of delirium and reduces the need for analgesics and sedatives. Material and Method: Multicenter, prospective, randomized, placebo-controlled double blind study. Patients over 18 years old, admitted in ICUs, without mechanical ventilation and in use of analgesics and/or sedatives were included. The patients were randomized to receive Melatonin 10 mg or placebo by oral or nasogastric tube, administered at 20 h for a maximum of seven days. The time of night sleep was evaluated by Nursing annotations. The depth, latency, quality of sleep and number of awakenings by Richards Campbell Sleep Questionnaire (RCSQ) performed by a psychologist. A check-list of delirium, pain and anxiety scale (Visual Analogue Scale-Anxiety) were applied. The use of analgesics and sedatives was evaluated daily. The dosage of Melatonin serum levels was performed by enzyme-linked immunosorbent assay (ELISA). Results: A total of 203 patients were included. The quality of sleep assessed by the CSR was better in the Melatonin group (69.7 ±21.2) than in the placebo group (60.7 ±26.3) (P=0.029). Very good sleep (score above 75) was observed in 45.8% in the Melatonin group and 34.4% in the placebo group (RR= 1.33, 95% CI = 0.938-1.89) and very poor sleep in 3.1% of the Melatonin group vs. 14.6% of the placebo group (RR = 0.21 95% CI = 0.06-0.71). There was no difference between the groups in relation to the days free of painkillers and sedatives, at the time of night sleep in the ICU, delirium, pain and anxiety. Measurements of Melatonin serum levels have confirmed to be related to its exogenous administration and proper absorption of the drug. The Melatonin group demonstrated peak Melatonin serum levels at 2:00 a.m., 150 pg/mL (125-2,125) vs. 32.5 pg/mL (18.5-35) placebo group (P <0.001). Conclusion: Melatonin in this study was associated with increased sleep quality; since this result has demonstrated Melatonin as a promising further role in the composition of the ICU therapeutic arsenal.