Factors Disrupting Melatonin Secretion Rhythms During Critical Illness
| Autor: | Bryan D. Lizza, Eric M. Liotta, Maged Gendy, Kathryn J. Reid, Sabra M. Abbott, Andrew M. Naidech, John Eed, Phyllis C. Zee, Matthew B. Maas |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Time Factors Light Organ Dysfunction Scores Critical Illness Rest Encephalopathy Physiology Critical Care and Intensive Care Medicine Severity of Illness Index Article Sepsis Melatonin 03 medical and health sciences 0302 clinical medicine Intensive care Zeitgeber medicine Humans Glasgow Coma Scale Prospective Studies Circadian rhythm Aged Cerebral Hemorrhage Aged 80 and over Intracerebral hemorrhage Academic Medical Centers Brain Diseases business.industry Organ dysfunction 030208 emergency & critical care medicine Middle Aged medicine.disease Circadian Rhythm Diet Intensive Care Units 030228 respiratory system Female medicine.symptom Arousal business medicine.drug |
| Zdroj: | Crit Care Med |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000004333 |
| Popis: | Objectives The circadian system modulates many important physiologic processes, synchronizing tissue-specific functions throughout the body. We sought to characterize acute alterations of circadian rhythms in critically ill patients and to evaluate associations between brain dysfunction, systemic multiple organ dysfunction, environmental stimuli that entrain the circadian rhythm (zeitgebers), rest-activity rhythms, and the central circadian rhythm-controlled melatonin secretion profile. Design Prospective study observing a cohort for 24-48 hours beginning within the first day of ICU admission. Setting Multiple specialized ICUs within an academic medical center. Patients Patients presenting from the community with acute onset of either intracerebral hemorrhage as a representative neurologic critical illness or sepsis as a representative systemic critical illness. Healthy control patients were studied in using modified constant routine in a clinical research unit. Interventions None. Measurements and main results Light, feeding, activity, medications, and other treatment exposures were evaluated along with validated measures of encephalopathy (Glasgow Coma Scale), multiple organ system function (Sequential Organ Failure Assessment score), and circadian rhythms (profiles of serum melatonin and its urinary metabolite 6-sulphatoxymelatonin). We studied 112 critically ill patients, including 53 with sepsis and 59 with intracerebral hemorrhage. Environmental exposures were abnormal, including light (dim), nutritional intake (reduced or absent and mistimed), and arousal stimuli (increased and mistimed). Melatonin amplitude and acrophase timing were generally preserved in awake patients but dampened and delayed with increasing encephalopathy severity. Melatonin hypersecretion was observed in patients exposed to catecholamine vasopressor infusions, but unaffected by sedatives. Change in vasopressor exposure was the only factor associated with changes in melatonin rhythms between days 1 and 2. Conclusions Encephalopathy severity and adrenergic agonist medication exposure were the primary factors contributing to abnormal melatonin rhythms. Improvements in encephalopathy and medical stabilization did not rapidly normalize rhythms. Urinary 6-sulphatoxymelatonin is not a reliable measure of the central circadian rhythm in critically ill patients. |
| Databáze: | OpenAIRE |
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