Melatonin and melatonin agonists to prevent and treat delirium in critical illness: A systematic review protocol

被引：12
作者：
Foster J. [1 ,2 ,3 ]
Burry L.D. [4 ,5 ]
Thabane L. [6 ,7 ,8 ,9 ,10 ]
Choong K. [10 ,11 ]
Menon K. [12 ,13 ,14 ]
Duffett M. [10 ,11 ]
Cheung A. [5 ]
Guenette M. [5 ]
Chimunda T. [15 ,16 ]
Rose L. [17 ,18 ,19 ,20 ,21 ]
机构：
[1] Western University, Department of Paediatrics, Schulich School of Medicine and Dentistry, London
[2] Dalhousie University, IWK Health Centre, 5850/5980 University Avenue, Halifax, B3K 6R8, NS
[3] Children's Health Research Institute, Division of Children's Health and Therapeutics, London
[4] University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON
[5] Mount Sinai Hospital, Department of Pharmacy, 600 University Avenue, Room 18-377, Toronto, M5G1X5, ON
[6] McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton
[7] St. Joseph's Healthcare, Biostatistics Unit, Centre for Evaluative Medicine, Hamilton, ON
[8] Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON
[9] McMaster University, Department of Anesthesia, Hamilton, ON
[10] McMaster University, Department of Pediatrics, Hamilton, ON
[11] McMaster Children's Hospital, Pediatric Critical Care Unit, 1200 Main Street West, Hamilton, L8N 3Z5, ON
[12] Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, K1H 8L1, ON
[13] Children's Hospital of Eastern Ontario, Division of Critical Care, Department of Pediatrics, Ottawa, ON
[14] University of Ottawa, Departments of Pediatrics and Epidemiology and Community Medicine, Ottawa, ON
[15] University of Toronto, Department of Anesthesia, Toronto, ON
[16] School of Medicine, University of Queensland, Brisbane, 4072, QLD
[17] Sunnybrook Health Sciences Centre, Department of Critical Care Medicine, 2075 Bayview Avenue, Toronto, M4N 3M5, ON
[18] Sunnybrook Research Institute, Evaluative Clinical Sciences, Trauma, Emergency and Critical Care Research Program, Toronto, ON
[19] University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON
[20] Institute for Clinical Evaluative Sciences, Toronto, ON
[21] Toronto East General Hospital, Provincial Centre of Weaning Excellence, Toronto, ON
来源：
Systematic Reviews | / 5卷 / 1期
关键词：
Delirium; Intensive care; Melatonin; Melatonin agonists; Prevention; Systematic review; Treatment;
D O I：
10.1186/s13643-016-0378-2
中图分类号：
学科分类号：
摘要：
Background: Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA) have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes. The objective of this review is to synthesize the available evidence pertaining to the efficacy and safety of MMA for the prevention and treatment of ICU delirium. Methods: We will search Ovid MEDLINE, Web of Science, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL to identify studies evaluating MMA in critically ill populations. We will also search http://apps.who.int/trialsearch for ongoing and unpublished studies and PROSPERO for registered reviews. We will not impose restrictions on language, date, or journal of publication. Authors will independently screen for eligible studies using pre-defined criteria; data extraction from eligible studies will be performed in duplicate. The Cochrane Risk of Bias Scale and the Newcastle-Ottawa Scale will be used to assess the risk of bias and quality of randomized and non-randomized studies, respectively. Our primary outcome of interest is delirium incidence, and secondary outcomes include duration of delirium, number of delirium- and coma-free days, use of physical and chemical (e.g., antipsychotics or benzodiazepines) restraints, duration of mechanical ventilation, ICU and hospital length of stay, mortality, long-term neurocognitive outcomes, hospital discharge disposition, and adverse events. We will use Review Manager (RevMan) to pool effect estimates from included studies. We will present results as relative risks with 95% confidence intervals for dichotomous outcomes and as mean differences, or standardized mean differences, for continuous outcomes. Discussion: Current guidelines make no pharmacological recommendations for either the prevention or treatment of ICU delirium. This systematic review will synthesize the available evidence on the efficacy and safety of MMA for this purpose, thus potentially informing clinical decision-making and improving patient outcomes. Systematic review registration:PROSPERO CRD42015024713. © 2016 The Author(s).
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