• Robyn Thom, Melissa Bui, Bernard Rosner, Polina Teslyar, Nomi Levy-Carrick, David Wolfe, and Michael Klompas.
• Brigham and Women's Hospital, Department of Psychiatry, Boston, MA. Electronic address: rthom1@partners.org.
• Psychosomatics. 2019 May 1; 60 (3): 289-297.

BackgroundDelirium commonly affects critically ill patients and is associated with high morbidity and mortality. Some studies have suggested that ramelteon may prevent delirium, but ramelteon's impact on treating delirium is unknown.ObjectiveTo compare outcomes of critically ill delirious patients treated with ramelteon versus those who were not.MethodsRetrospective cohort study of 322 intensive care unit patients stratified based on ramelteon exposure after a nonnegative Confusion Assessment Method-ICU score.Main OutcomesPrimary 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.ResultsHazard 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.ConclusionsRamelteon was not associated with increased likelihood of delirium-coma resolution, extubation, or changes in mortality.Copyright © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.

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