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Los niveles sanguíneos farmacológicos de melatonina aumentan la capacidad antioxidante total en pacientes críticos.
Melatonin Pharmacological Blood Levels Increase Total Antioxidant Capacity in Critically Ill Patients.
Mistraletti G1,2, Paroni R3, Umbrello M4, D'Amato L5, Sabbatini G6, Taverna M7, Formenti P8, Finati E9, Favero G10, Bonomini F11, Rezzani R12, Reiter RJ13, Iapichino G14,15.
Int J Mol Sci. 2017 Apr 3;18(4). pii: E759. doi: 10.3390/ijms18040759.
Abstract
In this study, the aim was to test the biochemical effects of melatonin supplementation in Intensive Care Unit (ICU) patients, since their blood levels are decreased. Sixty-four patients were enrolled in the study. From the evening of the 3rd ICU day, patients were randomized to receive oral melatonin (3 mg, group M) or placebo (group P) twice daily, at 20:00 and 24:00, until discharged. Blood was taken (at 00:00 and 14:00), on the 3rd ICU day to assess basal nocturnal melatonin values, and then during the treatment period on the 4th and 8th ICU days. Melatonin, total antioxidant capacity, and oxidative stress were evaluated in serum. Melatonin circadian rhythm before treatment was similar in the two groups, with a partial preservation of the cycle. Four hours from the 1st administration (4th ICU day, 00:00), melatonin levels increased to 2514 (982.3; 7148) pg·mL-1 in group M vs. 20.3 (14.7; 62.3) pg·mL-1 in group P (p < 0.001). After five treatment days (8th ICU day), melatonin absorption showed a repetitive trend in group M, while in group P nocturnal secretion (00:00) was impaired: 20 (11.5; 34.5) pg·mL-1 vs. 33.8 (25.0; 62.2) on the 3rd day (p = 0.029). Immediately from the beginning of treatment, the total antioxidant capacity was significantly higher in melatonin treated subjects at 00:00; a significant correlation was found between total antioxidant capacity and blood melatonin values (ρ = 0.328; p < 0.001). The proposed enteral administration protocol was adequate, even in the early phase, to enhance melatonin blood levels and to protect the patients from oxidative stress. The antioxidant effect of melatonin could play a meaningful role in the care and well-being of these patients.
KEYWORDS: antioxidants; critical illness; dietary supplements; melatonin; oxidative stress
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Melatonina profiláctica para el delirio en cuidados intensivos (Pro-MEDIC): protocolo de estudio para un ensayo controlado aleatorizado.
Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a randomised controlled trial.
Martinez FE1, Anstey M2,3,4, Ford A5, Roberts B6, Hardie M7, Palmer R6, Choo L7, Hillman D8,9, Hensley M10, Kelty E11, Murray K12, Singh B13,14,15, Wibrow B2,16.
Trials. 2017 Jan 6;18(1):4. doi: 10.1186/s13063-016-1751-0.
Abstract
BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. METHODS: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72 h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4 mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14 days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. DISCUSSION: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU.
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Agonistas del receptor de la melatonina para la prevención del delirio
Melatonin Receptor Agonists for Delirium Prevention.
Ann Pharmacother. 2017 Jan;51(1):72-78. doi: 10.1177/1060028016665863. Epub 2016 Aug 20.
Abstract
OBJECTIVE: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention. DATA SOURCES: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included. The references of identified articles were reviewed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION: Controlled clinical trials in humans, limited to the English language, were reviewed. Five randomized and 1 nonrandomized prospective controlled clinical trial exploring the use of melatonin receptor agonists for delirium preventionwere evaluated. DATA SYNTHESIS: Melatonin agonist therapy for delirium prevention has produced conflicting results in clinical trials. Delirium incidence ranged from no change to significant reductions of approximately 12% to 30%. Four trials were conducted with melatonin as the investigated agent, 1 with l-tryptophan, and 1 with ramelteon. The study setting also varied, with 4 trials being conducted in surgical patients and 2 trials in medical patients. Melatonin provided conflicting results, with 3 trials showing decreased delirium incidence and the largest randomized controlled trial showing no benefit. No benefit was found using l-tryptophan in delirium prevention. The single, small ramelteon trial showed decreased delirium incidence. Safety evaluations during trials were limited. Three trials found adverse effects similar to placebo, whereas the remaining 3 trials did not evaluate adverse effects. CONCLUSIONS: The routine use of melatonin receptor agonists for delirium prevention cannot be recommended at this time.
KEYWORDS: delirium; melatonin; melatonin-receptor agonist; ramelteon; tryptophan
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Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
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Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú
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X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018.
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V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
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Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
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