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González-Seguel F, Letelier-Bernal R. Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review. Phys Ther 2024; 104:pzae048. [PMID: 38519113 PMCID: PMC11184528 DOI: 10.1093/ptj/pzae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/12/2023] [Accepted: 01/30/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit. METHODS In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (>48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IGs) and the comparator groups (CGs) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT). RESULTS Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n = 7), progressive mobility (n = 6), leg cycling (n = 3), tilt table (n = 1), and multicomponent (n = 6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them. CONCLUSIONS Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG. IMPACT The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit.
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Affiliation(s)
- Felipe González-Seguel
- School of Physical Therapy, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | - Renato Letelier-Bernal
- Programa de Magíster en Fisiología Clínica del Ejercicio, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
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Lehmkuhl L, Olsen HT, Brønd JC, Rothmann MJ, Dreyer P, Jespersen E. Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit. Acta Anaesthesiol Scand 2023; 67:462-469. [PMID: 36636823 DOI: 10.1111/aas.14195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU. METHOD In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh- and chest-worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in-bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA. RESULTS We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non-lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00. CONCLUSION ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse- and/or physiotherapy-initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU.
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Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, Odense University Hospital Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
- Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Section of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
- Bergen University, Bergen, Norway
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Chapple LAS, Parry SM, Schaller SJ. Attenuating Muscle Mass Loss in Critical Illness: the Role of Nutrition and Exercise. Curr Osteoporos Rep 2022; 20:290-308. [PMID: 36044178 PMCID: PMC9522765 DOI: 10.1007/s11914-022-00746-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Impaired recovery following an intensive care unit (ICU) admission is thought related to muscle wasting. Nutrition and physical activity are considered potential avenues to attenuate muscle wasting. The aim of this review was to present evidence for these interventions in attenuating muscle loss or improving strength and function. RECENT FINDINGS Randomised controlled trials on the impact of nutrition or physical activity interventions in critically ill adult patients on muscle mass, strength or function are presented. No nutrition intervention has shown an effect on strength or function, and the effect on muscle mass is conflicting. RCTs on the effect of physical activity demonstrate conflicting results; yet, there is a signal for improved strength and function with higher levels of physical activity, particularly when commenced early. Further research is needed to elucidate the impact of nutrition and physical activity on muscle mass, strength and function, particularly in combination.
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Affiliation(s)
- Lee-Anne S Chapple
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
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Gupta P, Martin JL, Malhotra A, Bergstrom J, Grandner MA, Kamdar BB. Circadian rest-activity misalignment in critically ill medical intensive care unit patients. J Sleep Res 2022; 31:e13587. [PMID: 35388552 PMCID: PMC9489597 DOI: 10.1111/jsr.13587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/06/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Circadian alignment of rest-activity rhythms is an essential biological process that may be vulnerable to misalignment in critically ill patients. We evaluated circadian rest-activity rhythms in critically ill patients and their association with baseline (e.g. age) and clinical (e.g. mechanical ventilation status) variables, along with intensive care unit light-dark cycles. Using wrist actigraphy, we collected 48-hr activity and light exposure data from critically ill patients in a tertiary care medical intensive care unit. We evaluated circadian rest-activity rhythms using COSINOR and non-parametric circadian rhythm analysis models, and stratified these data across baseline and clinical variables. We used linear regression to evaluate the association of circadian rest-activity and light-dark exposure rhythms. In COSINOR and non-parametric circadian rhythm analysis analyses, the 34 medical intensive care unit patients completing 48-hr actigraphy recordings exhibited mean MESOR (mean activity levels of a fitted curve) and amplitudes of 0.50 ± 0.32 and 0.20 ± 0.19 movements per 30-s epoch, with high interdaily variability. Patients who were older, mechanically ventilated, sedated, restrained and with higher organ failure scores tended to exhibit greater circadian rest-activity misalignment, with three of 34 (9%) patients exhibiting no circadian rhythmicity. Circadian light-dark exposure misalignment was observed as well and was associated with rest-activity misalignment (p = 0.03). Critically ill patients in our MICU experienced profound circadian rest-activity misalignment, with mostly weak or absent rhythms, along with circadian light-dark exposure misalignment. Potentially modifiable factors contributing to rest-activity misalignment (i.e. mechanical ventilation, restraints, low daytime light levels) highlight possible targets for future improvement efforts.
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Affiliation(s)
- Prerna Gupta
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer L. Martin
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | - Jaclyn Bergstrom
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Michael A. Grandner
- Sleep and Health Research Program, University of Arizona, Tucson, Arizona, USA
| | - Biren B. Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
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Implementation of Early Rehabilitation in Severe COVID-19 Respiratory Failure. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022; 14:63-77. [PMID: 36968180 PMCID: PMC10032217 DOI: 10.1097/jat.0000000000000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/09/2022] [Indexed: 11/26/2022]
Abstract
The purpose of this scoping review is to describe current clinical practice guidelines (CPGs) for early rehabilitation for individuals hospitalized in an intensive care unit with COVID-19 and examine practice patterns for implementation of mobility-related interventions. Methods PubMed, EMBASE, and CINAHL databases were searched from January 1, 2020, through April 1, 2022. Selected studies included individuals hospitalized with severe COVID-19 and provided objective criteria for clinical decision making for mobility interventions. A total of 1464 publications were assessed for eligibility and data extraction. The PRISMA-ScR Checklist and established guidelines for reporting for scoping reviews were followed. Results Twelve articles met inclusion criteria: 5 CPGs and 7 implementation articles. Objective clinical criteria and guidelines for implementation of early rehabilitation demonstrated variable agreement across systems. No significant adverse events were reported. Conclusions Sixty percent (3/5) of CPGs restrict mobility for individuals requiring ventilatory support of more than 60% Fio2 (fraction of inspired oxygen) and/or positive end-expiratory pressure (PEEP) greater than 10-cm H2O (positive end-expiratory pressure). Preliminary evidence from implementation studies may suggest that some individuals with COVID-19 requiring enhanced ventilatory support outside of established parameters may be able to safely participate in mobility-related interventions, though further research is needed to determine safety and feasibility to guide clinical decision making.
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Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults: A Feasibility Prospective Observational Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lam MTY, Malhotra A, LaBuzetta JN, Kamdar BB. Sleep in Critical Illness. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sanchez REA, Wrede JE, Watson RS, de la Iglesia HO, Dervan LA. Actigraphy in mechanically ventilated pediatric ICU patients: comparison to PSG and evaluation of behavioral circadian rhythmicity. Chronobiol Int 2021; 39:117-128. [PMID: 34634983 DOI: 10.1080/07420528.2021.1987451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sleep disruption is common in pediatric intensive care unit (PICU) patients, but measuring sleep in this population is challenging. We aimed to evaluate the utility of actigraphy for estimating circadian rhythmicity in mechanically ventilated PICU patients and its accuracy for measuring sleep by comparing it to polysomnogram (PSG). We conducted a single-center prospective observational study of children 6 months - 17 years of age receiving mechanical ventilation and standard, protocolized sedation for acute respiratory failure, excluding children with acute or historical neurologic injury. We enrolled 16 children and monitored them with up to 14 days of actigraphy and 24 hours of simultaneous limited (10 channel) PSG. Daily actigraphy-based activity profiles demonstrated that patients had a high level of nighttime activity (30-41% of total activity), suggesting disrupted circadian activity cycles. Among n = 12 patients with sufficient actigraphy and PSG data overlap, actigraphy-based sleep estimation showed poor agreement with PSG-identified sleep states, with good sensitivity (94%) but poor specificity (28%), low accuracy (70%,) and low agreement (Cohen's kappa = 0.2, 95% CI = 0.08-0.31). Using univariate linear regression, we identified that Cornell Assessment of Pediatric Delirium scores were associated with accuracy of actigraphy but that other clinical factors including sedative medication doses, activity levels, and restraint use were not. In this population, actigraphy did not reliably discern between sleep and wake states. However, in select patients, actigraphy was able to distinguish diurnal variation in activity patterns, and therefore may be useful for evaluating patients' response to circadian-oriented interventions.
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Affiliation(s)
| | - Joanna E Wrede
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington, USA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Horacio O de la Iglesia
- Department of Biology, University of Washington, Seattle, Washington, USA.,Graduate Program in Neuroscience, University of Washington, Seattle, Washington, USA
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
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Rollinson TC, Connolly B, Berlowitz DJ, Berney S. Physical activity of patients with critical illness undergoing rehabilitation in intensive care and on the acute ward: An observational cohort study. Aust Crit Care 2021; 35:362-368. [PMID: 34389239 DOI: 10.1016/j.aucc.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND There are limited published data on physical activity of survivors of critical illness engaged in rehabilitation in hospital, despite it plausibly influencing outcome. OBJECTIVE The aims of this study were to measure physical activity of patients with critical illness engaged in rehabilitation in the intensive care unit (ICU) and on the acute ward and report discharge destination, muscle strength, and functional outcomes. METHODS This was a single-centre, prospective observational study. Adults with critical illness, who received ≥48 h of invasive mechanical ventilation, and who were awake and able to participate in rehabilitation were eligible. To record physical activity, participants wore BodyMedia SenseWear Armbands (BodyMedia Incorporated, USA), during daylight hours, from enrolment until hospital discharge or day 14 of ward stay (whichever occurred first). The primary outcome was time (minutes) spent performing physical activity at an intensity of greater than 1.5 Metabolic Equivalent Tasks. Secondary outcomes included discharge destination, muscle strength, and physical function. RESULTS We collected 807 days of physical activity data (363 days ICU, 424 days ward) from 59 participants. Mean (standard deviation) duration of daily physical activity increased from the ICU, 17.8 (22.8) minutes, to the ward, 52.8 (51.2) minutes (mean difference [95% confidence interval] = 35 [23.8-46.1] minutes, P < .001). High levels of activity in the ICU were associated with higher levels of activity on the ward (r = .728), n = 48, P < .001. CONCLUSIONS Patients recovering from critical illness spend less than 5% of the day being physically active throughout hospital admission, even when receiving rehabilitation. Physical activity increased after discharge from intensive care, but had no relationship with discharge destination. Only the absence of ICU-acquired weakness on awakening was associated with discharge directly home from the acute hospital. Future studies could target early identification of ICU-acquired weakness and the preservation of muscle strength to improve discharge outcomes.
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Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom
| | - David J Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Via-Clavero G, Frade-Mera MJ, Alonso-Crespo D, Castanera-Duro A, Gil-Castillejos D, Vallés-Fructuoso O, Rodríguez-Mondéjar JJ, López-López C, Robleda G, Acevedo-Nuevo M. Future lines of research on pain care, sedation, restraints and delirium in the critically ill patient. ENFERMERIA INTENSIVA 2021; 32:57-61. [PMID: 34099265 DOI: 10.1016/j.enfie.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- G Via-Clavero
- Enfermera Clínica, Área del Paciente Crítico, Hospital Universitari de Bellvitge, Profesora Asociada, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Grup de Recerca Infermera (GRIN-IDIBELL), Spain.
| | - M J Frade-Mera
- Enfermera Clínica, Área del Paciente Crítico, Hospital Universitario 12 de Octubre, Profesora Asociada, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - D Alonso-Crespo
- Enfermero, Unidad de Cuidados Intensivos, Área Sanitaria de Vigo, Hospital Álvaro Cunqueiro SERGAS-UVigo, Translational Neuroscience Group-CIBERSAM, Galicia Sur, Instituto de Investigación Sanitaria (IIS Galicia Sur), Spain
| | - A Castanera-Duro
- Enfermero Clínico, Área del paciente crítico, Hospital Universitario de Girona Dr. Josep Trueta, Profesor Asociado departamento de Enfermería Universitat de Girona (UdG), Spain
| | - D Gil-Castillejos
- Enfermera Clínica, Área de Críticos, Servicio de Medicina Intensiva, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - O Vallés-Fructuoso
- Enfermera, Unidad de Cuidados Intensivos, Hospital Vall d'Hebrón, Barcelona, Spain
| | - J J Rodríguez-Mondéjar
- Enfermero en UME-2 Alcantarilla, Gerencia de Urgencias y Emergencias Sanitarias 061 Región de Murcia, Servicio Murciano de Salud, Profesor asociado en la Facultad de Enfermería de la Universidad de Murcia, Campus Mare Nostrum, Miembro del grupo de investigación ENFERAVAN en el IMIB-Arrixaca, Spain
| | - C López-López
- Enfermera, Departamento de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, Investigadora, Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Profesora Asociada, Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid, Spain
| | - G Robleda
- Campus docente Fundación Privada Sant Joan de Déu, Escuela de Enfermería, Universidad de Barcelona, Centro Cochrane Iberoamericano, Spain
| | - M Acevedo-Nuevo
- Enfermera, Organización Nacional de Trasplantes, Grupo de Investigación en Enfermería y Cuidados de Salud - Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Spain
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Via-Clavero G, Frade-Mera MJ, Alonso-Crespo D, Castanera-Duro A, Gil-Castillejos D, Vallés-Fructuoso O, Rodríguez-Mondéjar JJ, López-López C, Robleda G, Acevedo-Nuevo M. Future lines of research on pain care, sedation, restraints and delirium in the critically ill patient. ENFERMERIA INTENSIVA 2021; 32:57-61. [PMID: 33966878 DOI: 10.1016/j.enfi.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Gemma Via-Clavero
- Enfermera Clínica, Área del Paciente Crítico. Hospital Universitari de Bellvitge. Profesora Asociada. Escuela de Enfermería. Facultad de Medicina y Ciencias de la Salud. Universitat de Barcelona. Grup de Recerca Infermera (GRIN-IDIBELL).
| | - María Jesús Frade-Mera
- Enfermera Clínica, Área del Paciente Crítico. Hospital Universitario 12 de Octubre. Profesora Asociada. Facultad de Enfermería, Fisioterapia y Podología. Universidad Complutense de Madrid
| | - David Alonso-Crespo
- Enfermero, Unidad de Cuidados Intensivos. Área Sanitaria de Vigo. Hospital Álvaro Cunqueiro SERGAS-UVigo. Translational Neuroscience Group-CIBERSAM, Galicia Sur. Instituto de Investigación Sanitaria (IIS Galicia Sur)
| | - Aaron Castanera-Duro
- Enfermero Clínico. Área del paciente crítico. Hospital Universitario de Girona Dr. Josep Trueta. Profesor Asociado departamento de Enfermería Universitat de Girona (UdG)
| | - Diana Gil-Castillejos
- Enfermera Clínica, Área de Críticos. Servicio de Medicina Intensiva. Hospital Universitari Joan XXIII, Tarragona
| | | | - Juan José Rodríguez-Mondéjar
- Enfermero en UME-2 Alcantarilla. Gerencia de Urgencias y Emergencias Sanitarias 061 Región de Murcia. Servicio Murciano de Salud. Profesor asociado en la Facultad de Enfermería de la Universidad de Murcia. Campus Mare Nostrum. Miembro del grupo de investigación ENFERAVAN en el IMIB-Arrixaca
| | - Candelas López-López
- Enfermera, Departamento de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid. Investigadora, Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid. Profesora Asociada, Facultad de Enfermería Fisioterapia y Podología, Universidad Complutense de Madrid
| | - Gemma Robleda
- Campus docente Fundación Privada Sant Joan de Déu. Escuela de Enfermería, Universidad de Barcelona. Centro Cochrane Iberoamericano
| | - María Acevedo-Nuevo
- Enfermera, Organización Nacional de Trasplantes. Grupo de Investigación en Enfermería y Cuidados de Salud - Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA)
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Tonna JE, Dalton A, Presson AP, Zhang C, Colantuoni E, Lander K, Howard S, Beynon J, Kamdar BB. The Effect of a Quality Improvement Intervention on Sleep and Delirium in Critically Ill Patients in a Surgical ICU. Chest 2021; 160:899-908. [PMID: 33773988 DOI: 10.1016/j.chest.2021.03.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delirium is a deleterious condition affecting up to 60% of patients in the surgical ICU (SICU). Few SICU-focused delirium interventions have been implemented, including those addressing sleep-wake disruption, a modifiable delirium risk factor common in critically ill patients. RESEARCH QUESTION What is the effect on delirium and sleep quality of a multicomponent nonpharmacologic intervention aimed at improving sleep-wake disruption in patients in the SICU setting? STUDY DESIGN AND METHODS Using a staggered pre-post design, we implemented a quality improvement intervention in two SICUs (general surgery or trauma and cardiovascular) in an academic medical center. After a preintervention (baseline) period, a multicomponent unit-wide nighttime (ie, efforts to minimize unnecessary sound and light, provision of earplugs and eye masks) and daytime (ie, raising blinds, promotion of physical activity) intervention bundle was implemented. A daily checklist was used to prompt staff to complete intervention bundle elements. Delirium was evaluated twice daily using the Confusion Assessment Method for the Intensive Care Unit. Patient sleep quality ratings were evaluated daily using the Richards-Campbell Sleep Questionnaire (RCSQ). RESULTS Six hundred forty-six SICU admissions (332 baseline, 314 intervention) were analyzed. Median age was 61 years (interquartile range, 49-70 years); 35% of the cohort were women and 83% were White. During the intervention period, patients experienced fewer days of delirium (proportion ± SD of ICU days, 15 ± 27%) as compared with the preintervention period (20 ± 31%; P = .022), with an adjusted pre-post decrease of 4.9% (95% CI, 0.5%-9.2%; P = .03). Overall RCSQ-perceived sleep quality ratings did not change, but the RCSQ noise subscore increased (9.5% [95% CI, 1.1%-17.5%; P = .02). INTERPRETATION Our multicomponent intervention was associated with a significant reduction in the proportion of days patients experienced delirium, reinforcing the feasibility and effectiveness of a nonpharmacologic sleep-wake bundle to reduce delirium in critically ill patients in the SICU. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03313115; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT.
| | - Anna Dalton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah Health, Salt Lake City, UT
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah Health, Salt Lake City, UT
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Kirsten Lander
- Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City, UT
| | - Sullivan Howard
- Surgical Intensive Care Unit, Critical Care, University of Utah Health, Salt Lake City, UT
| | - Julia Beynon
- AirMed & Emergency Nursing, University of Utah Health, Salt Lake City, UT
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, School of Medicine, La Jolla, CA
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