ICU Ed and Todd-Cast New: MELLOW, Melatonin, and Mailbag
Oct 7, 2025
The hosts dive into melatonin's role in delirium prevention, spotlighting the intriguing MELLOW trial. They explore its creative acronym and share insights on trial feasibility and enrollment challenges. A meta-analysis suggests a modest benefit, while varying results across patient populations raise questions. The discussion also touches on the complexities of delirium management and the potential for nurse-driven protocols. Finally, practical considerations about sternal intraosseous access in trauma settings round out an engaging conversation.
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Melatonin Interest Vs Uneven Evidence
- Melatonin has substantial interest as a low‑risk, widely available intervention for ICU delirium prevention.
- Multiple recent trials and a meta‑analysis show mixed, small, or low‑certainty effects rather than clear benefit.
Use Melatonin Judiciously
- Consider melatonin use because it is safe and widely available despite uncertain efficacy.
- Use clinical judgement; don't prioritize it over stronger, evidence‑based delirium measures.
Why Delirium Trials Often Fail
- Delirium likely has multiple etiologies which dilutes effects of single interventions.
- Heterogeneity and small effect sizes may explain many neutral RCTs of delirium therapies.