Impact of Adjuvant Mannitol Administration on the Development of Delirium in Patients with Myocardial Infarction: Results of a Single-Center Pilot Study.

Delirium is a severe neuropsychiatric syndrome associated with a prolonged hospital stay and adverse outcomes. Background/Objectives: The aim of this study was to evaluate the efficacy and safety of mannitol in patients with myocardial infarction (MI) for the prevention of delirium. Methods: A single-center, pilot, randomized, controlled clinical trial was conducted from 29 December 2024 to 9 May 2025. The study enrolled MI patients aged 65 years and older, with a pain-to-door time of less than 24 h, and a serum C-reactive protein (CRP) level exceeding 25 mg/L. In the mannitol group (n = 20), patients received a single 1 g/kg dose of intravenous mannitol. In the control group (n = 20), patients received standard therapy for MI. The primary outcome was the incidence of delirium. Secondary outcomes included the length of stay in the intensive care unit (ICU), the length of hospital stay, and in-hospital mortality. Results. The incidence of delirium in the mannitol group was 10% compared to 45% in the control group (OR = 7.3636 95% CI: 1.3372-40.5492; z = 2.294; p = 0.0218). The ICU LOS, in-hospital LOS, and in-hospital mortality did not differ between the two groups. Conclusions. Mannitol prescription for MI patients at high risk of delirium may be an effective and safe strategy for its prevention.