title: The Use of Modafinil in the Intensive Care Unit.
abstract: As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit. Our 3 patients were chosen as a result of their fatigue, EDS, and/or depression, which prolonged their ICU stay and precluded them from participating in physical therapy, an integral component of the rehabilitative process. The patients were given 200 mg of modafinil each morning to increase patient wakefulness, encourage their participation, and enable a more restful sleep during the night. Although the drug was undoubtedly not the sole reason why our patients became more active, the temporal relationship between starting the drug and our patients' clinical improvement makes it likely that it contributed. Based on our observations with these patients, the known effects of modafinil, its safety profile, and the published experiences of others, we believe that modafinil has potential benefits when utilized in some critically ill patients and that the consequences of delayed patient recovery and a prolonged ICU stay may outweigh the risks of potential modafinil side effects.
authors.affiliation: Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ, USA michal.gajewski@rutgers.edu.
authors.forename: Michal
authors.initials: M
authors.lastname: Gajewski
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Weinhouse
mesh_terms: D000368:Aged; D001559:Benzhydryl Compounds / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy*; D005221:Fatigue / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D000077408:Modafinil; D013514:Surgical Procedures, Operative / Q000534:rehabilitation*; D016896:Treatment Outcome; D064690:Wakefulness-Promoting Agents / Q000627:therapeutic use*
chemical_list: D001559:Benzhydryl Compounds; D064690:Wakefulness-Promoting Agents; D000077408:Modafinil
keywords: Provigil; modafinil; psychostimulants; rehabilitation; sleep cycle