Biochemical markers for the circadian rhythm were studied in patients treated at the ICU (intensive care unit) of two regional hospitals. A normal rhythm is characterized by a relatively higher melatonin and a lower cortisol excretion at night. Disturbances affect sleep, mood and cognitive performance. All urine excreted between 07:00 and 22:00 hours (day) and between 22:00 and 07:00 hours (night) was collected and sampled throughout the entire ICU period (median, 10 days) in 16 patients for the excretion of 6-SMT (6-sulphatoxymelatonin), which is a metabolite of melatonin, and free cortisol. The overall excretion of 6-SMT was slightly lower and the cortisol excretion higher than reported for healthy reference populations. Mechanical ventilation was associated with a markedly lower 6-SMT excretion (median, 198 ng/h) compared with periods without such help (555 ng/h; P<0.0001), whereas infusion of adrenergic drugs increased the 6-SMT excretion (P<0.01). Five patients (31%) showed a virtually absent melatonin excretion for 24 h or more. The diurnal rhythms were consistently or periodically disturbed in 65% and 75% of the patients. These alterations cannot be explained by excessive exposure to light at night. In conclusion, there was hyposecretion of melatonin during mechanical ventilation, an overall high cortisol excretion and a disturbed diurnal rhythm of both of these hormones in most patients treated in two ICU departments.
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July 2004
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Research Article|
June 23 2004
Low melatonin excretion during mechanical ventilation in the intensive care unit
Ulla FRISK;
Ulla FRISK
*Department of Anaesthesia, South Hospital, Stockholm, Sweden
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Joel OLSSON;
Joel OLSSON
1
†Department of Anaesthesia, Regional Hospital, Gällivare, Sweden
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Per NYLÉN;
Per NYLÉN
‡Department of Ergonomics, National Institute for Working Life, Stockholm, Sweden
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Robert G. HAHN
*Department of Anaesthesia, South Hospital, Stockholm, Sweden
Correspondence: Professor Robert G. Hahn (e-mail Robert.Hahn@sos.sll.se).
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Publisher: Portland Press Ltd
Received:
November 14 2003
Revision Received:
February 19 2004
Accepted:
February 24 2004
Accepted Manuscript online:
February 24 2004
Online ISSN: 1470-8736
Print ISSN: 0143-5221
The Biochemical Society
2004
Clin Sci (Lond) (2004) 107 (1): 47–53.
Article history
Received:
November 14 2003
Revision Received:
February 19 2004
Accepted:
February 24 2004
Accepted Manuscript online:
February 24 2004
Citation
Ulla FRISK, Joel OLSSON, Per NYLÉN, Robert G. HAHN; Low melatonin excretion during mechanical ventilation in the intensive care unit. Clin Sci (Lond) 1 July 2004; 107 (1): 47–53. doi: https://doi.org/10.1042/CS20030374
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