ICU sedation, delirium & recovery
Effectiveness and safety of melatoninergic agonists in preventing delirium in the intensive care unit (ICU): an updated dose‒response meta-analysis of randomized controlled trials
Pooled result · Incidence of deliriumResult — go to the resultEstimate 0.77 CI 0.62,0.94Authors' conclusion
Our findings indicate that melatoninergic agonists probably reduce the risk of delirium in ICU patients, especially those treated with MEL, in surgical-type ICUs and for durations equal to or longer than 7 days, with an optimal cumulative dose of 22 mg.
Study context
- Population
- ICU patients
- Participants
- 3,680 patients · 24 studies
- Comparison
- Melatoninergic agonists vs placebo
- Outcome
- Incidence of delirium
Methodological detailspairwise dose-response meta-analysis, meta-regression, trial sequential analysis, GRADE, ICEMAN subgroup credibility
- Pairwise dose-response meta-analysis
- Meta-regression
- Trial sequential analysis
- GRADE
- ICEMAN subgroup credibility
Pooled result
As reported in the abstract
Estimate
0.77
CI 0.62,0.94
Further pooled results
| Outcome | RR (CI) | |
|---|---|---|
| Incidence of delirium, MEL subgroupMEL vs Placebo | 0.77 (0.62–0.97) | |
| Incidence of delirium, surgical-type ICU subgroup | 0.64 (0.48–0.87) | |
| Delirium, dose-response (cumulative MEL dose)MEL 22 mg cumulative vs Placebo · nonlinear dose-response; optimal cumulative dose 22 mg | 0.732 (0.599–0.895) | |
| Incidence of delirium, intervention ≥ 7 days subgroup | 0.73 (0.60–0.90) | |
| 0.512Relative risk (log scale) |
| Outcome | MD (CI) | |
|---|---|---|
| ICU LOSMCID −0.113 [1.846, −2.073]; clinically relevant trend | −0.74 (−1.60 to 0.12) | |
| Hospital LOSMCID −0.134 [1.833, −2.108]; clinically relevant trend | −0.33 (−1.91 to 1.25) | |
| Length of mechanical ventilationMCID −0.2146 [1.744, −2.173]; clinically relevant trend | −0.50 (−1.16 to 0.16) | |
| Time to onset of deliriumVery-low certainty | 0.76 (0.43–1.09) | |
| −2−1012Difference (linear scale) |
Incidence of delirium, intervention ≥ 7 days subgroup
- Significant effect of intervention duration on risk of delirium (subgroup and meta-regression)
28-30-day or ICU mortality
- Not affected by melatoninergic agonists
Safety
Incidence of adverse effects
- Not affected by melatoninergic agonists
Original publication
Effectiveness and safety of melatoninergic agonists in preventing delirium in the ICU: an updated dose‒response meta-analysis of randomized controlled trials. Crit Care. Published 17 June 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →