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Effects of Stellate Ganglion Block on Delirium and Circadian Rhythm in Geriatric Intensive Care Patients

11. maj 2026 opdateret af: Antalya Training and Research Hospital

Effects of Stellate Ganglion Block on Delirium and Circadian Rhythm in Geriatric Intensive Care Patients: A Prospective Randomized Controlled Trial

Delirium is a common complication in elderly intensive care unit (ICU) patients and is associated with poor clinical outcomes. Circadian rhythm disruption is considered an important contributing factor in delirium development. Stellate ganglion block (SGB) may modulate autonomic nervous system activity and improve circadian rhythm regulation.

This prospective randomized placebo-controlled trial aims to evaluate the effects of ultrasound-guided stellate ganglion block on delirium incidence and circadian rhythm in ICU patients aged 65 years and older. Delirium will be assessed using validated clinical scales, and circadian rhythm will be evaluated through serial measurements of serum melatonin and plasma cortisol levels

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Delirium is a common and serious complication among elderly intensive care unit (ICU) patients and is associated with increased morbidity, mortality, prolonged hospitalization, and poor long-term outcomes. Although the pathophysiology of delirium is multifactorial, growing evidence suggests that disruption of circadian rhythm and autonomic nervous system imbalance play an important role in its development. Current pharmacological and non-pharmacological treatment strategies remain limited, highlighting the need for novel preventive and therapeutic approaches.

Stellate ganglion block (SGB) is an ultrasound-guided autonomic modulation technique that has been shown to influence sympathetic activity, sleep regulation, and circadian rhythm. However, its potential role in reducing ICU delirium and modulating circadian biomarkers has not been clearly established.

This study is designed as a prospective, randomized, placebo-controlled to investigate the effects of ultrasound-guided stellate ganglion block on delirium and circadian rhythm in geriatric ICU patients. Eligible patients aged 65 years and older will be randomized in a 1:1 ratio to receive either stellate ganglion block with 0.5% bupivacaine or placebo saline injection. Randomization will be computer-generated, and outcome assessors will be blinded to group allocation.

Delirium will be assessed twice daily for seven days using validated clinical tools, including the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). Delirium severity will be evaluated using the Delirium Rating Scale-Revised-98, and motor subtypes (hyperactive, hypoactive, mixed) will be categorized according to RASS scores. Sleep quality will be assessed using the Richards-Campbell Sleep Questionnaire.

To evaluate circadian rhythm, serum melatonin and plasma cortisol levels will be measured at predefined circadian time points during the first three days following ICU admission. The study combines objective biomarker assessment with standardized delirium evaluation to explore potential mechanistic pathways linking autonomic modulation and neurocognitive outcomes.

The primary objective is to determine whether stellate ganglion block reduces delirium incidence in elderly ICU patients. Secondary objectives include evaluating delirium severity, motor subtype distribution, sleep quality, circadian biomarker changes, and ICU and hospital length of stay. This trial aims to provide mechanistic and clinical evidence regarding the potential role of stellate ganglion block in ICU delirium management.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

130

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

  • Navn: Nilgun Kavrut Ozturk, professor
  • Telefonnummer: +905334196049
  • E-mail: kavrut@yahoo.com

Undersøgelse Kontakt Backup

Studiesteder

  • Tyrkiet (Türkiye)
    • Muratpaşa
      • Antalya, Muratpaşa, Tyrkiet (Türkiye), 07100
        • Antalya Training And Research Hospital
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • Patients aged 65 years or older expected to remain in the intensive care unit for more than 48 hours
  • RASS score > -4

Exclusion Criteria:

  • History of neurodegenerative disease (e.g., Alzheimer's disease, dementia, vascular dementia)
  • Uncontrolled psychiatric disorders
  • Alcohol use disorder and/or substance abuse
  • History of traumatic brain injury or ischemic/hemorrhagic cerebrovascular event
  • Severe hearing and/or visual impairment
  • Benzodiazepine use
  • Renal failure (Acute Kidney Injury stage 2-3) and/or liver failure
  • Beta-blocker use
  • Contraindications to stellate ganglion block (e.g., coagulopathy, glaucoma, recent myocardial infarction)
  • Sepsis
  • Allergy to bupivacaine
  • Inability to communicate in Turkish or English
  • Severe hyponatremia
  • Hemodynamic instability

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Andet
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Placebo Group
Ultrasound-guided intramuscular injection of 2 mL normal saline to the anterolateral cervical region
Procedure: Placebo Injection
Ultrasound-guided sham procedure will be performed, consisting of 2 mL normal saline administered as an intramuscular injection into the anterolateral cervical region, without targeting the stellate ganglion.
Eksperimentel: Stellate Ganglion Block Group
Ultrasound-guided stellate ganglion block using 5 mL of 0.5% bupivacaine
Procedure: stellate ganglion block with 0.5% bupivacaine
Ultrasound-guided stellate ganglion block will be performed in the supine position using 5 mL of 0.5% bupivacaine administered by an experienced anesthesiologist.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of delirium
Tidsramme: From randomization until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed twice daily (06:00-08:00 and 20:00-22:00).
Delirium incidence will be assessed in patients receiving stellate ganglion block and in patients not receiving stellate ganglion block using a standardized two-step evaluation process. Patients will first be assessed with the Richmond Agitation-Sedation Scale (RASS), which ranges from -5 (unarousable) to +4 (combative). Only patients with a RASS score greater than -4 will undergo delirium assessment using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), a validated diagnostic instrument for delirium. Delirium will be recorded as present or absent according to CAM-ICU findings. Higher RASS scores indicate increased agitation, whereas lower scores indicate deeper sedation. Minimum and maximum scores are not applicable to CAM-ICU because it is used as a binary diagnostic tool rather than a numerical scale.
From randomization until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed twice daily (06:00-08:00 and 20:00-22:00).

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Serum melatonin circadian pattern
Tidsramme: From ICU admission to Day 3 (samples collected at predefined circadian time points: 03:00, 08:00, and 16:00)
Serum melatonin levels will be measured at predefined time points to assess circadian rhythm pattern. Blood samples will be obtained at 03:00, 08:00, and 16:00. Results will be reported in pg/mL. Circadian rhythm assessment will be based on whether the temporal profile of melatonin secretion across these predefined sampling times is consistent with the expected physiological circadian pattern, rather than on isolated measurements alone.
From ICU admission to Day 3 (samples collected at predefined circadian time points: 03:00, 08:00, and 16:00)
Plasma cortisol circadian pattern
Tidsramme: From ICU admission to Day 3, measured three times daily at predefined time points (03:00, 08:00, and 16:00).
Plasma cortisol levels will be measured at predefined time points to assess circadian rhythm pattern. Blood samples will be obtained at 03:00, 08:00, and 16:00. Results will be reported in µg/dL. Circadian rhythm assessment will be based on whether the temporal profile of cortisol secretion across these predefined sampling times is consistent with the expected physiological circadian pattern, rather than on isolated measurements alone.
From ICU admission to Day 3, measured three times daily at predefined time points (03:00, 08:00, and 16:00).
Delirium severity (Delirium Rating Scale-Revised-98 score)
Tidsramme: From the first diagnosis of delirium until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
Delirium severity will be assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98), which ranges from 0 to 46. Higher scores indicate more severe delirium. The scale will be applied only in patients diagnosed with delirium according to CAM-ICU.
From the first diagnosis of delirium until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
Delirium motor subtype distribution
Tidsramme: From the first diagnosis of delirium until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
Delirium motor subtypes will be classified as hyperactive, hypoactive, or mixed based on the Richmond Agitation-Sedation Scale (RASS) scores in patients diagnosed with delirium using CAM-ICU. Hyperactive delirium will be defined as RASS > 0, hypoactive delirium as RASS < 0, and mixed delirium as fluctuation between positive and negative RASS scores during the assessment period. The outcome will be reported as the distribution of delirium subtypes across study groups.
From the first diagnosis of delirium until Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
Sleep quality (Richards-Campbell Sleep Questionnaire score)
Tidsramme: From ICU admission to Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
Sleep quality will be assessed using the Richards-Campbell Sleep Questionnaire (RCSQ), which consists of five items evaluating sleep depth, sleep latency, number of awakenings, ease of returning to sleep, and overall sleep quality. Each item is scored on a visual analog scale from 0 to 100, and the overall score is calculated as the mean of the five items. Higher scores indicate better perceived sleep quality.
From ICU admission to Day 7 of ICU stay or ICU discharge, whichever occurs first, assessed daily.
ICU and hospital length of stay
Tidsramme: From hospital admission to discharge home or in-hospital death, whichever occurs first, calculated as total days of hospitalization, assessed up to 60 days.
Hospital length of stay will be defined as the total number of days from hospital admission to hospital discharge.
From hospital admission to discharge home or in-hospital death, whichever occurs first, calculated as total days of hospitalization, assessed up to 60 days.

Samarbejdspartnere og efterforskere

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Sponsor

Antalya Training and Research Hospital

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

6. maj 2026

Primær færdiggørelse (Anslået)

1. januar 2027

Studieafslutning (Anslået)

1. februar 2027

Datoer for studieregistrering

Først indsendt

26. marts 2026

Først indsendt, der opfyldte QC-kriterier

27. april 2026

Først opslået (Faktiske)

30. april 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

13. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

11. maj 2026

Sidst verificeret

1. maj 2026

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