title: Delirium and Circadian Rhythm of Melatonin During Weaning From Mechanical Ventilation: An Ancillary Study of a Weaning Trial.
abstract: BACKGROUND
  Delirium is frequent in patients in the ICU, but its association with the outcome of weaning from mechanical ventilation has not been assessed. Circadian rhythm alteration may favor delirium. In the current study, we assessed the impact of delirium during weaning and associated alterations in the circadian rhythm of melatonin excretion.
  
  
  METHODS
  This was a substudy of 70 participants of the B-type Natriuretic Peptide for the Fluid Management of Weaning trial, comparing two fluid management strategies during weaning. Patients with or without delirium (as assessed using the Confusion Assessment Method for the ICU) were compared in terms of baseline characteristics and outcomes and the circadian rhythm of melatonin excretion using the 24-h excretion of its urinary metabolite 6-sulfatoxymelatonin (aMT6s).
  
  
  RESULTS
  Among the 70 patients included, 43 (61.4%) experienced delirium at the initiation of weaning. Delirium at the initiation of weaning was associated with more alcohol consumption, a greater severity of illness, and medication use before weaning (including neuromuscular blockade, antibiotics, sedatives, and narcotics). Delirium at the initiation of weaning was associated with more respiratory and neurologic complications and a reduced probability of successful extubation (Cox multivariate model hazard ratio of successful extubation = 0.54; 95% CI, 0.30-0.95; P = .03). Delirium was also associated with a significant reduction in peak, mean, amplitude, and total values of aMT6s urinary excretion during the first 24 h of weaning (general linear model F statistic = 5.81, P = .019).
  
  
  CONCLUSIONS
  Delirium is frequent at the initiation of ventilator weaning. It is associated with a prolongation of weaning and an alteration in the circadian rhythm of melatonin excretion.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT00473148; URL: www.clinicaltrials.gov.
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, Groupe de recherche clinique CARMAS, Créteil, France. Electronic address: armand.dessap@hmn.aphp.fr.
authors.forename: Armand Mekontso
authors.initials: AM
authors.lastname: Dessap
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; Hospital Verge de la Cinta, Servei de Medicina Intensiva, Tortosa, Tarragona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
authors.affiliation: AP-HP, Hôpital Lariboisière, Service de Biochimie, Paris, France; INSERM, Unité U942, Paris, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Launay
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France; Sorbonne Universités, UPMC INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France.
authors.forename: Anais
authors.initials: A
authors.lastname: Charles-Nelson
authors.affiliation: AP-HP, Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, Paris, France; Sorbonne Universités, UPMC INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France; Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, Groupe de recherche clinique CARMAS, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Keenan Research Centre and Critical Care Department, St. Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000368:Aged; D000720:Ancillary Services, Hospital; D002940:Circadian Rhythm; D003693:Delirium / Q000209:etiology / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008550:Melatonin / Q000031:analogs & derivatives* / Q000652:urine; D008875:Middle Aged; D012121:Respiration, Artificial; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*
chemical_list: C054513:6-sulfatoxymelatonin; D008550:Melatonin