MTP4.01 Assessing the Effectiveness of Melatonin as a Reactive Intervention for Post-Operative Delirium in Cardiac ICU Patients: A Retrospective Cohort Study

Post-operative delirium is a significant challenge in the cardiac intensive care unit (ICU), contributing to prolonged admissions, extended hospital stays, and increased mortality. Traditional pharmacological treatments, such as benzodiazepines and antipsychotics, have notable side effects, highlighting the need for safer alternatives. Previous studies have suggested melatonin’s potential as a prophylactic measure against ICU delirium. This study aimed to evaluate melatonin as a reactive treatment for post-operative delirium in cardiac ICU patients. We performed a retrospective cohort analysis of 127 delirium-diagnosed patients (confirmed by a positive CAM-ICU score), dividing them into two groups: melatonin (n=57) and non-melatonin (n=70). The primary outcome was delirium regression (negative CAM-ICU score), with secondary outcomes including ICU stay length, total hospital stay, and mechanical ventilation duration. Delirium regression occurred in 42.1% of the melatonin group compared to 32.9% in the non-melatonin group (p=0.356). Binomial regression analysis showed no significant association between melatonin use and delirium regression (OR: 0.845, 95% CI: 0.329-2.172, p=0.727). However, ICU length of stay (OR: 1.126, p=0.003) and mechanical ventilation duration (OR: 0.897, p=0.004) were significant predictors. In comparing melatonin dosages, 33.3% of patients in the 2mg group, 46.7% in the 5mg group, and 44.4% in the 10mg group showed delirium regression (p=0.718). In conclusion, while prophylactic melatonin use is supported by prior studies, our findings suggest it may not be effective as a reactive treatment for post-operative delirium in cardiac ICU patients. Further research with larger sample sizes and improved control of confounding variables is warranted to clarify results.