Ramelteon is Not Associated With Improved Outcomes Among Critically Ill Delirious Patients: A Single-Center Retrospective Cohort Study

Background Delirium commonly affects critically ill patients and is associated with high morbidity and mortality. Some previous studies have suggested that ramelteon may prevent delirium, but ramelteon's impact on treating delirium is unknown. Objective To compare outcomes of critically ill delirious patients treated with ramelteon versus those who were not. Methods Retrospective cohort study of 322 intensive care unit patients stratified based on ramelteon exposure after a nonnegative Confusion Assessment Method-ICU score. Main outcomes Primary outcomes were hours alive without delirium or coma and likelihood of delirium-coma resolution. Secondary outcomes were ventilator-free hours, likelihood of extubation, and mortality. Results Hazard ratios for delirium-coma resolution, extubation, and 10-day mortality were 1.05 (95% confidence interval 0.54–2.01), 1.20 (95% confidence interval 0.47–3.03), and 0.31 (95% confidence interval 0.07–1.32), respectively. Median delirium-coma free hours did not differ between ramelteon exposed and unexposed patients. Median ventilator-free hours were higher in the ramelteon group, however, ramelteon was administered postextubation in 92% of cases. Conclusions Ramelteon was not associated with increased likelihood of delirium-coma resolution, extubation, or changes in mortality.