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Park MJ, Yoo JH, Cho BW, Kim KT, Jeong WC, Ha M. Noise in hospital rooms and sleep disturbance in hospitalized medical patients. ENVIRONMENTAL HEALTH AND TOXICOLOGY 2014; 29:e2014006. [PMID: 25163680 PMCID: PMC4152942 DOI: 10.5620/eht.2014.29.e2014006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/25/2014] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Hospitalized patients are vulnerable to sleep disturbances because of environmental stresses including noise. While most previous studies on hospital noise and sleep have been performed for medical machines in intensive care units, there is a limited data for patients hospitalized in medical wardrooms. The purpose of present study was to measure noise level of medical wardrooms, identify patient-perceived sources of noise, and to examine the association between noise levels and sleep disturbances in hospitalized patients. METHODS Noise dosimeters were used to measure noise level in 29 inpatient wardrooms at a university hospital. Sleep pattern and disturbance were assessed in 103 hospitalized patients, using the Pittsburgh Sleep Quality Index (PSQI) and Leeds Sleep Evaluation Questionnaire. RESULTS The mean equivalent continuous noise level for 24 hours was 63.5 decibel A (dBA), which was far higher than 30 dBA recommended by the World Health Organization for hospital wardrooms. Other patients sharing a room were perceived as the most common source of noise by the patients, which was usually preventable. Of the patients in the study, 86% had bad sleep as assessed by the PSQI. The sleep disturbance was significantly correlated with increasing noise levels in a dose response manner. CONCLUSIONS Systemic organizational interventions are needed to keep wardrooms private and quiet to reduce sleep disturbance.
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Affiliation(s)
- Marn Joon Park
- Department of Otolaryngology, Asan Medical Center, Seoul, Korea
| | - Jee Hee Yoo
- Department of Internal Medicine, Hallym University Medical Center, Chuncheon, Korea
| | - Byung Wook Cho
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Ki Tae Kim
- Department of Cardiothoracic Surgery, Dankook University Hospital, Cheonan, Korea
| | | | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
- Correspondence: Mina Ha, MD. PhD 119 Dandae-ro, Dongnam-gu, Cheonan 330-714, Korea Tel: +82-41-550-3854 Fax: +82-41-556-6461 E-mail:
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Le Guen M, Nicolas-Robin A, Lebard C, Arnulf I, Langeron O. Earplugs and eye masks vs routine care prevent sleep impairment in post-anaesthesia care unit: a randomized study. Br J Anaesth 2014; 112:89-95. [DOI: 10.1093/bja/aet304] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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da Costa SV, Ceolim MF. [Factors that affect inpatients' quality of sleep]. Rev Esc Enferm USP 2013; 47:46-52. [PMID: 23515802 DOI: 10.1590/s0080-62342013000100006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 05/17/2012] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to identify factors that interfere with the sleep quality of patients admitted to a university hospital in a city in the state of São Paulo, Brazil. This was an exploratory, cross sectional study using non-probability sampling. Participants were 117 patients (59% men, mean age 48.0 years, standard deviation 16.9) hospitalized for at least 72 hours in stable clinical condition. The data were collected with an identification questionnaire and the Factors Affecting Sleep Quality (FASQ) questionnaire. Data processing was performed with descriptive statistics; each item of the FASQ underwent a test and a retest. The factors most often reported were waking up early (55.6%), disrupted sleep (52.1%), excessive lighting (34.2%), receipt of care by nursing staff (33.3%) and organic disorders such as pain and fatigue (26.5%). It is suggested that nurses should plan interventions to modify factors that require intense noise and lighting at night in order to reduce disruption and, consequently, sleep deprivation among patients.
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Tembo AC, Parker V, Higgins I. The experience of sleep deprivation in intensive care patients: findings from a larger hermeneutic phenomenological study. Intensive Crit Care Nurs 2013; 29:310-6. [PMID: 23806731 DOI: 10.1016/j.iccn.2013.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
Abstract
Sleep deprivation in critically ill patients has been well documented for more than 30 years. Despite the large body of literature, sleep deprivation remains a significant concern in critically ill patients in intensive care unit (ICU). This paper discusses sleep deprivation in critically ill patients as one of the main findings from a study that explored the lived experiences of critically ill patients in ICU with daily sedation interruption (DSI). Twelve participants aged between 20 and 76 years with an ICU stay ranging from three to 36 days were recruited from a 16 bed ICU in a large regional referral hospital in New South Wales (NSW), Australia. Participants were intubated, mechanically ventilated and subjected to daily sedation interruption during their critical illness in ICU. In-depth face to face interviews with the participants were conducted at two weeks after discharge from ICU. A second interview was conducted with eight participants six to eleven months later. Interviews were audio taped and transcribed. Data were analysed thematically. "Longing for sleep" and "being tormented by nightmares" capture the experiences and concerns of some of the participants. The findings suggest a need for models of care that seek to support restful sleep and prevent or alleviate sleep deprivation and nightmares. These models of care need to promote both quality and quantity of sleep in and beyond ICU and identify patients suffering from sleep deprivation to make appropriate referrals for treatment and support.
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Affiliation(s)
- Agness C Tembo
- Casual Academic University of Newcastle, Newcastle, Australia; Registered Nurse Newcastle Private Hospital, New Lambton Heights, Australia.
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Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306. [PMID: 23269131 DOI: 10.1097/ccm.0b013e3182783b72] [Citation(s) in RCA: 2309] [Impact Index Per Article: 209.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. METHODS The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding. CONCLUSION These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
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Gómez Sanz CA. [Quality of sleep in patients hospitalized in an intensive care unit]. ENFERMERIA INTENSIVA 2012; 24:3-11. [PMID: 23260809 DOI: 10.1016/j.enfi.2012.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 10/14/2012] [Accepted: 10/15/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Trouble sleeping is common in the elderly population and is attributed to changes that aging brings in the sleep architecture and circadian rhythm. The prevalence of insomnia shows a marked increase with advancing age, in a proportion of 14 to 32% among those over 65 years. If we add these physiological changes of sleep with those found in patients admitted to the Intensive Care Unit (ICU), the problem worsens. The prevalence of these disorders in these units is from 22 - 61%. Sleep deprivation may contribute to worsening of the patients. The main objective is to describe the quality of sleep of patients admitted to the Coronary ICU of the Hospital Miguel Servet and the environmental factors that contribute to these disorders. MATERIAL AND METHODS A total of 75 conscious and oriented patients in the Coronary ICU Hospital Miguel Servet were included. Data was collected between February 17 and April 30, 2011. The subjects were asked to state if they had slept well by means of a survey and to score the environmental factors that may have bothered them. RESULTS AND DISCUSSION Most patients said they had slept well (66.7%). Noise was the environmental factor that bothered them most. In analyzing the different noises, patients identified hearing people talking as being the most annoying. CONCLUSION Changes must be implemented in the unit that would favor restful sleep.
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Affiliation(s)
- C A Gómez Sanz
- Unidad Coronaria de Cuidados Intensivos, Hospital Universitario Miguel Servet, Zaragoza, España.
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Zetterlund P, Plos K, Bergbom I, Ringdal M. Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study. Intensive Crit Care Nurs 2012; 28:159-67. [PMID: 22579396 DOI: 10.1016/j.iccn.2011.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. AIM The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). METHODS In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. RESULTS The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. CONCLUSIONS Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.
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Affiliation(s)
- Per Zetterlund
- Operation Norr, AN/OP/IVA, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Johansson L, Bergbom I, Lindahl B. Meanings of being critically ill in a sound-intensive ICU patient room - a phenomenological hermeneutical study. Open Nurs J 2012; 6:108-16. [PMID: 22977654 PMCID: PMC3439833 DOI: 10.2174/1874434601206010108] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/23/2012] [Accepted: 06/18/2012] [Indexed: 01/17/2023] Open
Abstract
The aim of this study was to illuminate the meanings of being critically ill in a sound-intensive ICU patient
room, as disclosed through patients’ narratives. Patient rooms in ICUs are filled with loud activity and studies have
revealed sound levels comparable to those of a busy road above the patient’s head. There is a risk that the sound or noise
is disturbing and at worst a major problem for the patient, but there is a lack of knowledge concerning the patients’ own
experiences. Thirteen patients were asked to narrate their experiences of the sound environment in ICU patient rooms. The
interviews were analyzed using a phenomenological- hermeneutical method inspired by the philosophy of Ricoeur. Six
themes emerged from the analysis. Conclusion: The meanings of being a patient in a sound- intensive environment were
interpreted as never knowing what to expect next regarding noise, but also of being situated in the middle of an
uncontrollable barrage of noise, unable to take cover or disappear. This condition is not to be seen as static; for some
patients there is movement and change over time. The meanings indicate that the unpredictable shifts between silence and
disturbing sounds stress the critically ill patient and impede sleep and recovery. Our findings indicate the need to reduce
disturbing and unexpected sounds and noise around critically ill patients in high-tech environments in order to facilitate
wellbeing, sleep and recovery. Nurses have a vital role in developing such an environment.
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Affiliation(s)
- Lotta Johansson
- Institute of Health and Care Sciences. The Sahlgrenska Academy, University of Gothenburg, Sweden
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Zhu B, Dong Y, Xu Z, Gompf HS, Ward SAP, Xue Z, Miao C, Zhang Y, Chamberlin NL, Xie Z. Sleep disturbance induces neuroinflammation and impairment of learning and memory. Neurobiol Dis 2012; 48:348-55. [PMID: 22776332 DOI: 10.1016/j.nbd.2012.06.022] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 06/22/2012] [Accepted: 06/27/2012] [Indexed: 11/19/2022] Open
Abstract
Hospitalized patients can develop cognitive function decline, the mechanisms of which remain largely to be determined. Sleep disturbance often occurs in hospitalized patients, and neuroinflammation can induce learning and memory impairment. We therefore set out to determine whether sleep disturbance can induce neuroinflammation and impairment of learning and memory in rodents. Five to 6-month-old wild-type C57BL/6J male mice were used in the studies. The mice were placed in rocking cages for 24 h, and two rolling balls were present in each cage. The mice were tested for learning and memory function using the Fear Conditioning Test one and 7 days post-sleep disturbance. Neuroinflammation in the mouse brain tissues was also determined. Of the Fear Conditioning studies at one day and 7 days after sleep disturbance, twenty-four hour sleep disturbance decreased freezing time in the context test, which assesses hippocampus-dependent learning and memory; but not the tone test, which assesses hippocampus-independent learning and memory. Sleep disturbance increased pro-inflammatory cytokine IL-6 levels and induced microglia activation in the mouse hippocampus, but not the cortex. These results suggest that sleep disturbance induces neuroinflammation in the mouse hippocampus, and impairs hippocampus-dependent learning and memory in mice. Pending further studies, these findings suggest that sleep disturbance-induced neuroinflammation and impairment of learning and memory may contribute to the development of cognitive function decline in hospitalized patients.
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Affiliation(s)
- Biao Zhu
- Geriatric Anesthesia Research Unit, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129-2060, USA
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Patusky KL, Caldwell B, Unkle D, Ruck B. Incorporating the treatment of medical and psychiatric disorders in the critical care area. Crit Care Nurs Clin North Am 2012; 24:53-80. [PMID: 22405712 DOI: 10.1016/j.ccell.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Critical care areas are fast moving, often chaotic, and therefore confusing, even frightening, to patients attempting to understand what has happened to them. The nurse acts to mitigate these reactions by understanding the range of possibilities that can occur with patients, including potential psychiatric issues, and serving as patient advocate to ensure that appropriate treatment is initiated. Certainly there may be other psychiatric problems not described in the preceding text. The main possibilities are covered in this article. Assessing and acting early are tools the critical care nurse uses to meet patient needs and prevent behavioral problems that can interfere with life-preserving care.
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Affiliation(s)
- Kathleen L Patusky
- Graduate Programs, School of Nursing, University of Medicine & Dentistry of New Jersey, Newark, NJ 07101, USA.
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Abstract
Scientists are only beginning to fully understand the purpose of sleep and its underlying mechanisms. Lack of sleep is associated with many diseases, including infection, and with increased mortality. Lack of proper sleep is an important problem in the intensive care unit, and interventions have been designed to improve it. Sleep is associated with immune function, and this relationship is partially based on the physiological basis of sleep, sleep architecture, the sleep-wake cycle, cytokines and the hypothalamic-pituitary axis.
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Affiliation(s)
- Freda DeKeyser Ganz
- Freda DeKeyser Ganz is the head of the masters program, School of Nursing, Hadassah Hebrew University, Jerusalem, Israel
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Tembo AC, Parker V, Higgins I. Being in limbo: The experience of critical illness in intensive care and beyond. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojn.2012.23041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nseir S. Endotracheal cuff pressure monitoring: another alarm in the ICU? Am J Crit Care 2011; 20:422-3; author reply 423-4. [PMID: 22045132 DOI: 10.4037/ajcc2011725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patient's inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.
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Affiliation(s)
- Ellyn E Matthews
- College of Nursing, University of Colorado Denver, 13120 E 19th Ave, Aurora, CO 80045, USA.
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Sleep promotion in the intensive care unit—A survey of nurses’ interventions. Intensive Crit Care Nurs 2011; 27:138-42. [DOI: 10.1016/j.iccn.2011.03.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 03/03/2011] [Accepted: 03/04/2011] [Indexed: 11/17/2022]
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McMillian WD, Taylor S, Lat I. Sedation, analgesia, and delirium in the critically ill patient. J Pharm Pract 2010; 24:27-34. [PMID: 21507872 DOI: 10.1177/0897190010388139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most critically ill patients receive a myriad of psychoactive medications during their hospital stay. An understanding of the pharmacology of the more commonly used sedative and analgesic therapies enables the clinician to aptly utilize these medications and limit toxicity. A key to the appropriate provision of sedative and analgesic pharmacotherapy is a thorough patient assessment, use of validated monitoring tools, and defined therapeutic goals. Limiting these therapies while optimizing patient comfort has been shown to reduce the duration of mechanical ventilation and reduce intensive care unit (ICU) and hospital length of stay and should be the aim of the multidisciplinary medical team. This review is intended to provide the reader with a fundamental understanding of how to facilitate comfort of the mechanically ventilated critically ill adult patients and how to minimize medication-related toxicities.
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Affiliation(s)
- Wesley D McMillian
- Department of Pharmacy, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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Stolic S, Mitchell ML. Pain management for patients in cardiac surgical intensive care units has not improved over time. Aust Crit Care 2010; 23:157-9. [DOI: 10.1016/j.aucc.2010.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022] Open
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Sleep quality and acute pain severity among young adults with and without chronic pain: the role of biobehavioral factors. J Behav Med 2010; 33:335-45. [DOI: 10.1007/s10865-010-9263-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 04/22/2010] [Indexed: 01/16/2023]
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