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Shaikh H, Ionita R, Khan U, Park Y, Jubran A, Tobin MJ, Laghi F. Effect of Atypical Sleep EEG Patterns on Weaning From Prolonged Mechanical Ventilation. Chest 2024; 165:1111-1119. [PMID: 38211699 PMCID: PMC11214907 DOI: 10.1016/j.chest.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Approximately one-third of acute ICU patients display atypical sleep patterns that cannot be interpreted by using standard EEG criteria for sleep. Atypical sleep patterns have been associated with poor weaning outcomes in acute ICUs. RESEARCH QUESTION Do patients being weaned from prolonged mechanical ventilation experience atypical sleep EEG patterns, and are these patterns linked with weaning outcomes? STUDY DESIGN AND METHODS EEG power spectral analysis during wakefulness and overnight polysomnogram were performed on alert, nondelirious patients at a long-term acute care facility. RESULTS Forty-four patients had been ventilated for a median duration of 38 days at the time of the polysomnogram study. Eleven patients (25%) exhibited atypical sleep EEG. During wakefulness, relative EEG power spectral analysis revealed higher relative delta power in patients with atypical sleep than in patients with usual sleep (53% vs 41%; P < .001) and a higher slow-to-fast power ratio during wakefulness: 4.39 vs 2.17 (P < .001). Patients with atypical sleep displayed more subsyndromal delirium (36% vs 6%; P = .027) and less rapid eye movement sleep (4% vs 11% total sleep time; P < .02). Weaning failure was more common in the atypical sleep group than in the usual sleep group: 91% vs 45% (P = .013). INTERPRETATION This study provides the first evidence that patients in a long-term acute care facility being weaned from prolonged ventilation exhibit atypical sleep EEG patterns that are associated with weaning failure. Patients with atypical sleep EEG patterns had higher rates of subsyndromal delirium and slowing of the wakeful EEG, suggesting that these two findings represent a biological signal for brain dysfunction.
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Affiliation(s)
- Hameeda Shaikh
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Ramona Ionita
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Usman Khan
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Youngsook Park
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL
| | - Amal Jubran
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL; RML Specialty Hospital, Hinsdale, IL
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL.
| | - Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL; RML Specialty Hospital, Hinsdale, IL
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Showler L, Ali Abdelhamid Y, Goldin J, Deane AM. Sleep during and following critical illness: A narrative review. World J Crit Care Med 2023; 12:92-115. [PMID: 37397589 PMCID: PMC10308338 DOI: 10.5492/wjccm.v12.i3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023] Open
Abstract
Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.
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Affiliation(s)
- Laurie Showler
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Jeremy Goldin
- Sleep and Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Adam M Deane
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
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Zhao X, Yan J, Wu B, Zheng D, Fang X, Xu W. Sleep cycle in children with severe acute bronchopneumonia during mechanical ventilation at different depths of sedation. BMC Pediatr 2022; 22:589. [PMID: 36224544 PMCID: PMC9553625 DOI: 10.1186/s12887-022-03658-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the characteristics of sleep cycle in children with severe acute bronchopneumonia treated with invasive mechanical ventilation at different sedation depths. METHODS We included 35 pediatric patients with severe acute bronchopneumonia treated using mechanical ventilation in Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University. They were divided into deep sedation group (n = 21; ramsay score 5-6) and light sedation group (n = 14; ramsay score3-4) based on sedation depth achieved during mechanical ventilation. Long-term video electroencephalography (EEG) monitoring was performed within the first 24 h after starting mechanical ventilation and after weaning from mechanical ventilation and discontinuing sedatives and analgesics. The results were analyzed and compared with those of normal children to analyze changes in sleep cycle characteristics at different sedation depths and mechanical ventilation stages. RESULTS There were 29 cases altered sleep architecture. The deep sedation group had a significantly higher incidence of sleep architecture altered, total sleep duration, and non-rapid eye movement sleep-1 (NREM-1) loss incidence than the light sedation group. Moreover, the deep sedation group had a significantly lower awakening number and rapid eye movement sleep (REM) percentage than the light sedation group. The sleep cycle returned to normal in 27 (77%) patients without NREM-1 or REM sleep loss. CONCLUSIONS Deep sedation during mechanical ventilation allows longer total sleep duration, fewer awakenings, and an increased deep sleep proportion, but sleep architecture is severely altered. After weaning from mechanical ventilation and sedative discontinuation, lightly sedated children exhibit better sleep recovery.
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Affiliation(s)
- XueShan Zhao
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, San Hao Street, Heping District, Shenyang, LiaoNing Province, China
| | - JingLi Yan
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, San Hao Street, Heping District, Shenyang, LiaoNing Province, China
| | - Bo Wu
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, San Hao Street, Heping District, Shenyang, LiaoNing Province, China
| | - Duo Zheng
- Department of Nerve Function, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiuying Fang
- Department of Nerve Function, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, No.36, San Hao Street, Heping District, Shenyang, LiaoNing Province, China.
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Sun YM, Zhu SN, Zhang C, Li SL, Wang DX. Effect of low-dose dexmedetomidine on sleep quality in postoperative patients with mechanical ventilation in the intensive care unit: A pilot randomized trial. Front Med (Lausanne) 2022; 9:931084. [PMID: 36117973 PMCID: PMC9471089 DOI: 10.3389/fmed.2022.931084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Sleep disturbances are prevalent in patients requiring invasive mechanical ventilation in the intensive care unit (ICU) and are associated with worse outcomes. Sedative-dose dexmedetomidine may improve sleep quality in this patient population but is associated with adverse events. Herein, we tested the effect of low-dose dexmedetomidine infusion on nighttime sleep quality in postoperative ICU patients with invasive ventilation. Methods In this pilot randomized trial, 80 adult patients who were admitted to the ICU after non-cardiac surgery and required invasive mechanical ventilation were randomized to receive either low-dose dexmedetomidine (0.1 to 0.2 μg/kg/h, n = 40) or placebo (n = 40) for up to 72 h. The primary endpoint was overall subjective sleep quality measured using the Richards–Campbell Sleep Questionnaire (score ranges from 0 to 100, with a higher score indicating better quality) in the night of surgery. Secondary outcomes included sleep structure parameters monitored with polysomnography from 9:00 PM on the day of surgery to the next 6:00 AM. Results All 80 patients were included in the intention-to-treat analysis. The overall subjective sleep quality was median 52 (interquartile 20, 66) with placebo vs. 61 (27, 79) with dexmedetomidine, and the difference was not statistically significant (median difference 8; 95% CI: −2, 22; P = 0.120). Among 68 patients included in sleep structure analysis, those in the dexmedetomidine group tended to have longer total sleep time [median difference 54 min (95% CI: −4, 120); P = 0.061], higher sleep efficiency [median difference 10.0% (95% CI: −0.8%, 22.3%); P = 0.060], lower percentage of stage N1 sleep [median difference −3.9% (95% CI: −11.8%, 0.5%); P = 0.090], higher percentage of stage N3 sleep [median difference 0.0% (95% CI: 0.0%, 0.4%); P = 0.057], and lower arousal index [median difference −0.9 (95% CI −2.2, 0.1); P = 0.091] but not statistically significant. There were no differences between the two groups regarding the incidence of adverse events. Conclusion Among patients admitted to the ICU after surgery with intubation and mechanical ventilation, low-dose dexmedetomidine infusion did not significantly improve the sleep quality pattern, although there were trends of improvement. Our findings support the conduct of a large randomized trial to investigate the effect of low-dose dexmedetomidine in this patient population. Clinical trial registration ClinicalTrial.gov, identifier: NCT03335527.
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Affiliation(s)
- Yue-Ming Sun
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Sai-Nan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shuang-Ling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
- *Correspondence: Shuang-Ling Li
| | - Dong-Xin Wang
- Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, United States
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Factors Associated with and Prognosis Impact of Perceived Sleep Quality and Estimated Quantity in Patients Receiving Non-Invasive Ventilation for Acute Respiratory Failure. J Clin Med 2022; 11:jcm11154620. [PMID: 35956237 PMCID: PMC9369912 DOI: 10.3390/jcm11154620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The objectives of this study were (1) to determine factors associated with impaired sleep and (2) to evaluate the relationship between impaired sleep and the outcome. Methods. Secondary analysis of a prospective observational cohort study in 54 intensive care units in France and Belgium. Sleep quality was quantified by the patients with a semi-quantitative scale. Results. Among the 389 patients included, 40% reported poor sleep during the first night in the ICU and the median (interquartile) total sleep time was 4 h (2−5). Factors independently associated with poor sleep quality were the SOFA score (odds ratio [OR] 0.90, p = 0.037), anxiety (OR 0.43, p = 0.001) and the presence of air leaks (OR 0.52, p = 0.013). Factors independently associated with short-estimated sleep duration (<4 h) were the SOFA score (1.13, p = 0.005), dyspnea on admission (1.13, p = 0.031) and the presence of air leaks (1.92, p = 0.008). Non-invasive ventilation failure was independently associated with poor sleep quality (OR 3.02, p = 0.021) and short sleep duration (OR 0.77, p = 0.001). Sleep quality and duration were not associated with an increase in mortality or length of stay. Conclusions. The sleep of patients with ARF requiring NIV is impaired and is associated with a high rate of NIV failure.
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Grigg-Damberger MM, Hussein O, Kulik T. Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients. J Clin Neurophysiol 2022; 39:372-382. [PMID: 35239561 DOI: 10.1097/wnp.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.
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Boots R, Mead G, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Garner N, Clement P, Oddy D. Temperature Profile and Adverse Outcomes After Discharge From the Intensive Care Unit. Am J Crit Care 2022; 31:e1-e9. [PMID: 34972850 DOI: 10.4037/ajcc2022223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A predictive model that uses the rhythmicity of core body temperature (CBT) could be an easily accessible clinical tool to ultimately improve outcomes among critically ill patients. OBJECTIVES To assess the relation between the 24-hour CBT profile (CBT-24) before intensive care unit (ICU) discharge and clinical events in the step-down unit within 7 days of ICU discharge. METHODS This retrospective cohort study in a tertiary ICU at a single center included adult patients requiring acute invasive ventilation for more than 48 hours and assessed major clinical adverse events (MCAEs) and rapid response system activations (RRSAs) within 7 days of ICU discharge (MCAE-7 and RRSA-7, respectively). RESULTS The 291 enrolled patients had a median mechanical ventilation duration of 139 hours (IQR, 50-862 hours) and at admission had a median Acute Physiology and Chronic Health Evaluation II score of 22 (IQR, 7-42). At least 1 MCAE or RRSA occurred in 64% and 22% of patients, respectively. Independent predictors of an MCAE-7 were absence of CBT-24 rhythmicity (odds ratio, 1.78 [95% CI, 1.07-2.98]; P = .03), Sequential Organ Failure Assessment score at ICU discharge (1.10 [1.00-1.21]; P = .05), male sex (1.72 [1.04-2.86]; P = .04), age (1.02 [1.00-1.04]; P = .02), and Charlson Comorbidity Index (0.87 [0.76-0.99]; P = .03). Age (1.03 [1.01-1.05]; P = .006), sepsis at ICU admission (2.02 [1.13-3.63]; P = .02), and Charlson Comorbidity Index (1.18 [1.02-1.36]; P = .02) were independent predictors of an RRSA-7. CONCLUSIONS Use of CBT-24 rhythmicity can assist in stratifying a patient's risk of subsequent deterioration during general care within 7 days of ICU discharge.
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Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women’s Hospital, and Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gabrielle Mead
- Gabrielle Mead is an honors student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Oliver Rawashdeh
- Oliver Rawashdeh is a senior lecturer,, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, and Burns, Trauma and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - Jenny Paratz
- Jenny Paratz is an associate professor and a senior research fellow, Burns, Trauma and Critical Care Research Centre, The University of Queensland School of Medicine
| | - Nicholas Garner
- Nicholas Garner is a PhD student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is the clinical information systems manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - David Oddy
- David Oddy is the clinical data manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
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Evaluation of Sleep Architecture using 24-hour Polysomnography in Patients Recovering from Critical Illness in an Intensive Care Unit and High Dependency Unit: a Longitudinal, Prospective, and Observational Study. J Crit Care Med (Targu Mures) 2021; 7:257-266. [PMID: 34934815 PMCID: PMC8647672 DOI: 10.2478/jccm-2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background and objective The sleep architecture of critically ill patients being treated in Intensive Care Units (ICU) and High Dependency Units (HDU) is frequently unsettled and inadequate both qualitatively and quantitatively. The study aimed to investigate and elucidate factors influencing sleep architecture and quality in ICU and HDU in a limited resource setting with financial constraints, lacking human resources and technology for routine monitoring of noise, light and sleep promotion strategies in ICU. Methods The study was longitudinal, prospective, hospital-based, analytic, and observational. Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) pre hospitalisation scores were recorded. Patients underwent 24-hour polysomnography (PSG) with the simultaneous monitoring of noise and light in their environments. Patients stabilised in ICU were transferred to HDU, where the 24-hour PSG with the simultaneous monitoring of noise and light in their environments was repeated. Following PSG, the Richards-Campbell Sleep Questionnaire (RCSQ) was employed to rate patients’ sleep in both the ICU and HDU. Results Of 46 screened patients, 26 patients were treated in the ICU and then transferred to the HDU. The mean (SD) of the study population’s mean (SD) age was 35.96 (11.6) years with a predominantly male population (53.2% (n=14)). The mean (SD) of the ISI and ESS scores were 6.88 (2.58) and 4.92 (1.99), respectively. The comparative analysis of PSG data recording from the ICU and HDU showed a statistically significant reduction in N1, N2 and an increase in N3 stages of sleep (p<0.05). Mean (SD) of RCSQ in the ICU and the HDU were 54.65 (7.70) and 60.19 (10.85) (p-value = 0.04) respectively. The disease severity (APACHE II) has a weak correlation with the arousal index but failed to reach statistical significance (coeff= 0.347, p= 0.083). Conclusion Sleep in ICU is disturbed and persisting during the recovery period in critically ill. However, during recovery, sleep architecture shows signs of restoration.
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Abstract
OBJECTIVES Numerous risk factors for sleep disruption in critically ill adults have been described. We performed a systematic review of all risk factors associated with sleep disruption in the ICU setting. DATA SOURCES PubMed, EMBASE, CINAHL, Web of Science, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY SELECTION English-language studies of any design published between 1990 and April 2018 that evaluated sleep in greater than or equal to 10 critically ill adults (> 18 yr old) and investigated greater than or equal to 1 potential risk factor for sleep disruption during ICU stay. We assessed study quality using Newcastle-Ottawa Scale or Cochrane Risk of Bias tool. DATA EXTRACTION We abstracted all data independently and in duplicate. Potential ICU sleep disruption risk factors were categorized into three categories based on how data were reported: 1) patient-reported reasons for sleep disruption, 2) patient-reported ratings of potential factors affecting sleep quality, and 3) studies reporting a statistical or temporal association between potential risk factors and disrupted sleep. DATA SYNTHESIS Of 5,148 citations, we included 62 studies. Pain, discomfort, anxiety/fear, noise, light, and ICU care-related activities are the most common and widely studied patient-reported factors causing sleep disruption. Patients rated noise and light as the most sleep-disruptive factors. Higher number of comorbidities, poor home sleep quality, home sleep aid use, and delirium were factors associated with sleep disruption identified in available studies. CONCLUSIONS This systematic review summarizes all premorbid, illness-related, and ICU-related factors associated with sleep disruption in the ICU. These findings will inform sleep promotion efforts in the ICU and guide further research in this field.
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Role of sleep on respiratory failure after extubation in the ICU. Ann Intensive Care 2021; 11:71. [PMID: 33963951 PMCID: PMC8105690 DOI: 10.1186/s13613-021-00863-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
Background Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others. Results Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23). Conclusions Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00863-z.
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Elliott R, Chawla A, Wormleaton N, Harrington Z. Short-term physical health effects of sleep disruptions attributed to the acute hospital environment: a systematic review. Sleep Health 2021; 7:508-518. [PMID: 33875386 DOI: 10.1016/j.sleh.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/20/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
The sleep disruption experienced by patients admitted to hospital may have a negative effect on health but the nature and magnitude of the effect has not been conclusively outlined. The review was designed to examine the impact of sleep disruption associated with being a hospital inpatient, on short-term physical health outcomes in adult patients. Searches comprised journal databases, gray literature sources, and backward and forward citation searching. Two reviewers independently screened the records. Original studies of adult hospitalized patients' sleep were included if physical outcomes were also measured. Interventional studies were excluded. The methodological quality was assessed independently by 2 reviewers using CASP checklists. Sleep assessment measures and results, physical outcomes and contextual data were extracted. Results were synthesized according to frequently reported outcomes: delirium, pain intensity, physical strength, and respiratory function. A meta-analysis was not performed; studies were heterogeneous and reporting was limited. Of 9919 retrieved records, 26 published studies were included (published: 2001-2020). Risk of bias was moderately high. Confounding factors were poorly reported. Total sleep time was either normal or reduced. Sleep was disrupted: arousal indices were high (mean: 0 5-21/h); slow wave sleep proportions were limited. Subjective sleep quality was poor. The association between sleep reduction or disruption and short-term health outcomes was negative, mixed or equivocal and included increased delirium, higher pain intensity, poorer strength, and adverse respiratory function. The impact of sleep disruption on outcomes for hospitalized patients is not well defined.
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Affiliation(s)
- Rosalind Elliott
- Intensive care unit, Royal North Shore Hospital and Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, Australia; Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | - Archit Chawla
- Department of Respiratory Medicine, Liverpool Hospital, South Western Sydney Local Health District, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nicola Wormleaton
- NSLHD Libraries, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Zinta Harrington
- Department of Respiratory Medicine, Liverpool Hospital, South Western Sydney Local Health District, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
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Boots R, Mead G, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Garner N, Clement P, Oddy D. Circadian Hygiene in the ICU Environment (CHIE) study. CRIT CARE RESUSC 2020; 22:361-369. [PMID: 38046884 PMCID: PMC10692571 DOI: 10.51893/2020.4.oa9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the environment and care in the intensive care unit (ICU) and its relationship to patient circadian temperature disruption. Design: 30-day, prospective period prevalence study. Setting: 27-bed tertiary ICU. Participants: Patients expected to remain in the ICU for at least 24 hours. Main outcome measures: Temperature, relative humidity, light and sound intensity in the ICU; nursing interventions (using the Therapeutic Intervention Scoring System-28); and core body temperature of ICU patients. Results: Of 28 patients surveyed, 20 (71%) were mechanically ventilated. Median (interquartile range [IQR]) light intensity peaked at 07:00 at 165 (12-1218) lux with a trough at 23:00 of 15 (12-51) lux and was consistently < 100 lux between 21:00 and 06:00. Peak median (IQR) sound intensity was at 07:00 (62.55 [57.87-68.03] dB) while 58.84 (54.81-64.71) dB at 02:00. Ambient temperature and humidity varied with median (IQR) peaks of 23.11°C (22.74-23.31°C) at 16:00 and 44.07% (32.76-51.08%) at 11:00 and median troughs of 22.37°C (21.79-22.88°C) at 05:00 and 39.95% (31.53-47.95%) at 14:00, respectively. Disturbances to sleep during the night occurred due to care activities including linen changes (15 patients, 54%) and bathing (13, 46%). On the day before and the day of the study, 13 patients (47%) and 10 patients (36%), respectively, had a circadian rhythm on core body temperature without an association with illness severity, nursing intervention or environmental measures. Conclusions: The ICU has low light intensity with relative humidity and ambient temperature not aligned to normal human circadian timing. Noise levels are commonly equivalent to conversational speech while patient care procedures interrupt overnight sleep. The contribution of these factors to disrupted CBT rhythmicity is unclear.
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Affiliation(s)
- Rob Boots
- Thoracic Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Gabrielle Mead
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Oliver Rawashdeh
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Judith Bellapart
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Shane Townsend
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Jenny Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- School of Allied Health, Griffith University, Brisbane, QLD, Australia
| | - Nicholas Garner
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pierre Clement
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David Oddy
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - On behalf of the Circadian Investigators in Critical Illness
- Thoracic Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- School of Allied Health, Griffith University, Brisbane, QLD, Australia
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13
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Locihová H, Axmann K, Žiaková K. Sleep-disrupting effects of nocturnal nursing interventions in intensive care unit patients: A systematic review. J Sleep Res 2020; 30:e13223. [PMID: 33128479 DOI: 10.1111/jsr.13223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).
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Affiliation(s)
- Hana Locihová
- AGEL Research and Training Institute, Prostějov, AGEL Nemocnice Valašské Meziříčí, AGEL Střední zdravotnická škola, Ostrava, Czech Republic
| | - Karel Axmann
- Fakultní nemocnice Olomouc, Palacky University in Olomouc, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
| | - Katarína Žiaková
- Comenius University in Bratislava Jessenius Faculty of Nursing in Martin, Martin, Slovakia
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14
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Pinzon D, Galetke W. [Sleep in the intensive care unit]. SOMNOLOGIE 2020; 24:16-20. [PMID: 32431564 PMCID: PMC7222097 DOI: 10.1007/s11818-020-00246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/25/2020] [Indexed: 11/03/2022]
Abstract
Zahlreiche Patienten werden täglich auf Intensivstationen behandelt, häufig über einen längeren Zeitraum. Der Schlaf spielt eine nicht zu unterschätzende Rolle für diese Patienten. Schlafstörungen sind ein relevantes Problem für Intensivpatienten. Sie führen zu einer höheren Prävalenz eines Delirs bei diesen Patienten und somit zu einer längeren Verweildauer auf der Intensivstation und zu einer höheren Mortalität. Dieser Artikel versucht die Ursachen von Schlafstörungen in der Intensivmedizin und mögliche Strategien zur Vermeidung von Schlafstörungen aufzuzeigen.
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Affiliation(s)
- Daniel Pinzon
- Klinik für Pneumologie, VAMED Klinik Hagen Ambrock, Ambrocker Weg 60, 58091 Hagen, Deutschland
| | - Wolfgang Galetke
- Klinik für Pneumologie, VAMED Klinik Hagen Ambrock, Ambrocker Weg 60, 58091 Hagen, Deutschland
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15
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1750] [Impact Index Per Article: 350.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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16
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Jean R, Shah P, Yudelevich E, Genese F, Gershner K, Levendowski D, Martillo M, Ventura I, Basu A, Ochieng P, Gibson CD. Effects of deep sedation on sleep in critically ill medical patients on mechanical ventilation. J Sleep Res 2019; 29:e12894. [PMID: 31352685 PMCID: PMC7317530 DOI: 10.1111/jsr.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
Abstract
Atypical EEG patterns not consistent with standard sleep staging criteria have been observed in medical intensive care unit (ICU) patients. Our aim was to examine the relationship between sleep architecture and sedation in critically ill mechanically ventilated patients pre- and post-extubation. We performed a prospective observational repeated measures study where 50 mechanically ventilated patients with 31 paired analyses were examined at an academic medical centre. The sleep efficiency was 58.3 ± 25.4% for intubated patients and 45.6 ± 25.4% for extubated patients (p = .02). Intubated patients spent 76.33 ± 3.34% of time in non-rapid eye movement (NREM) sleep compared to 64.66 ± 4.06% of time for extubated patients (p = .02). REM sleep constituted 1.36 ± 0.67% of total sleep time in intubated patients and 2.06 ± 1.09% in extubated patients (p = .58). Relative sleep atypia was higher in intubated patients compared to extubated patients (3.38 ± 0.87 versus 2.79 ± 0.42; p < .001). Eleven patients were sedated with propofol only, 18 patients with fentanyl only, 11 patients with fentanyl and propofol, and 10 patients had no sedation. The mean sleep times on "propofol", "fentanyl", "propofol and fentanyl," and "no sedation" were 6.54 ± 0.64, 4.88 ± 0.75, 6.20 ± 0.75 and 4.02 ± 0.62 hr, respectively. The sigma/alpha values for patients on "propofol", "fentanyl", "propofol and fentanyl" and "no sedation" were 0.69 ± 0.04, 0.54 ± 0.01, 0.62 ± 0.02 and 0.57 ± 0.02, respectively. Sedated patients on mechanical ventilation had higher sleep efficiency and more atypia compared to the same patients following extubation. Propofol was associated with higher sleep duration and less disrupted sleep architecture compared to fentanyl, propofol and fentanyl, or no sedation.
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Affiliation(s)
- Raymonde Jean
- Department of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke's and Mount Sinai West, New York City, New York
| | - Purav Shah
- Department of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, Florida
| | | | - Frank Genese
- Department of Pulmonary and Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Katherine Gershner
- Department of Pulmonary and Critical Care Medicine, NYU Langone Health, New York City, New York
| | | | - Miguel Martillo
- Department of Critical Care Medicine and Surgery, The Mount Sinai Hospital, New York City, New York
| | - Iazsmin Ventura
- Department of Rheumatology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Anirban Basu
- Department of Pulmonary and Critical Care Medicine, New York-Presbyterian/Queens Hospital, Flushing, New York
| | - Pius Ochieng
- Department of Pulmonary and Critical Care Medicine, University of Pittsburgh Medical Center, Susquehanna, Pennsylvania
| | - Charlisa D Gibson
- Department of Pulmonary and Critical Care Medicine, NYU Langone Health, New York City, New York
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17
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Nava S, Pisani L. Patient-Clinician Alliance during Prolonged Mechanical Ventilation. "Never Give Up on a Dream". Am J Respir Crit Care Med 2019; 199:1453-1454. [PMID: 30896966 PMCID: PMC6580677 DOI: 10.1164/rccm.201901-0032ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefano Nava
- 1 Sant'Orsola Malpighi Hospital Alma Mater Studiorum, University of Bologna Bologna, Italy
| | - Lara Pisani
- 1 Sant'Orsola Malpighi Hospital Alma Mater Studiorum, University of Bologna Bologna, Italy
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18
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Prajapat B, Sandhya AS, Chaudhry D, Esquinas AM. Opioids in intensive care unit (ICU): causal agent for sleep apnea, unmasking the undiagnosed sleep apnea or both in the ICU. Sleep 2019; 41:4999660. [PMID: 29788470 DOI: 10.1093/sleep/zsy081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Brijesh Prajapat
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - A S Sandhya
- Department of Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Antonio M Esquinas
- Department of Intensive Care Unit, Hospital General Universitario Jose M Morales Meseguer, Murcia, Spain
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19
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Abstract
Melatonin is involved in regulation of a variety of physiologic functions, including circadian rhythm, reproduction, mood, and immune function. Exogenous melatonin has demonstrated many clinical effects. Numerous clinical studies have documented improved sleep quality following administration of exogenous melatonin. Recent studies also demonstrate the analgesic, anxiolytic, antiinflammatory, and antioxidative effects of melatonin. This article reviews the principal properties of melatonin and how these could find clinical applications in care of the critically ill patients.
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Affiliation(s)
- Annachiara Marra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Via S. Pansini 5, Naples 80138, Italy
| | - Tracy J McGrane
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 422, Nashville, TN 37212, USA
| | - Christopher Patrick Henson
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 422, Nashville, TN 37212, USA
| | - Pratik P Pandharipande
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 422, Nashville, TN 37212, USA.
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20
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Wang XT, Lyu L, Tang B, Wang C, Liu DW. Delirium in Intensive Care Unit Patients: Ten Important Points of Understanding. Chin Med J (Engl) 2018; 130:2498-2502. [PMID: 29052572 PMCID: PMC5684621 DOI: 10.4103/0366-6999.216405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lin Lyu
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia 014040, China
| | - Bo Tang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Cui Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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21
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Wilcox ME, Lim AS, Pinto R, Black SE, McAndrews MP, Rubenfeld GD. Sleep on the ward in intensive care unit survivors: a case series of polysomnography. Intern Med J 2018. [DOI: 10.1111/imj.13791] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mary Elizabeth Wilcox
- Department of Medicine (Critical Care Medicine); University Health Network; Toronto Ontario Canada
- Interdepartment Division of Critical Care Medicine; University of Toronto; Toronto Ontario Canada
| | - Andrew S. Lim
- Department of Medicine (Neurology); Sunnybrook Health Sciences Centre and University of Toronto; Toronto Ontario Canada
| | - Ruxandra Pinto
- Department of Medicine (Critical Care Medicine); Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Sandra E. Black
- Department of Medicine (Neurology); Sunnybrook Health Sciences Centre and University of Toronto; Toronto Ontario Canada
- Hurvitz Brain Sciences Research Program; Sunnybrook Research Institute and University of Toronto; Toronto Ontario Canada
| | - Mary Pat McAndrews
- Department of Medicine (Neuropsychology); University Health Network and University of Toronto; Toronto Ontario Canada
| | - Gordon D. Rubenfeld
- Interdepartment Division of Critical Care Medicine; University of Toronto; Toronto Ontario Canada
- Department of Medicine (Critical Care Medicine); Sunnybrook Health Sciences Centre; Toronto Ontario Canada
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22
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Abstract
Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.
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23
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Abstract
RATIONALE Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. OBJECTIVES This Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors. DATA SOURCES PubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017). DATA EXTRACTION Databases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance. SYNTHESIS A total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life. CONCLUSIONS Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.
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24
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Locihová H, Žiaková K. The effects of mechanical ventilation on the quality of sleep of hospitalised patients in the Intensive Care Unit. Rom J Anaesth Intensive Care 2018; 25:61-72. [PMID: 29756065 DOI: 10.21454/rjaic.7518.251.ven] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim To examine the effects of mechanical ventilation on the quality of sleep in patients in the intensive care unit (ICU) using recent and relevant literature. Methods To verify the examined objective, the results of the analysis of available original scientific works have been used including defined inclusion/exclusion criteria and search strategy. Appropriate works found were analysed further. The applied methodology was in line with the general principles of Evidence-Based Medicine. The following literary databases were used: CINAHL, Medline and gray literature: Google Scholar. Results A total of 91 trials were found. Eleven of these relevant to the follow-up analysis were selected: all trials were carried out under real ICU conditions and the total of 192 patients were included in the review. There is an agreement within all trials that sleep in patients requiring mechanical ventilation is disturbed. Most reviewed trials have shown that mechanical ventilation is probably not the main factor causing sleep disturbances, but an appropriate ventilation strategy can significantly help to improve its quality by reducing the frequency of the patient-ventilator asynchrony. Conclusion Based on the analysis, it appears that an appropriate ventilation mode setting can have a beneficial effect on the quality of sleep in ICU patients.
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Affiliation(s)
- Hana Locihová
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic.,AGEL Educational and Research Institute (VAVIA), Prostějov, Czech Republic
| | - Katarína Žiaková
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
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25
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Abstract
PURPOSE OF REVIEW The number of patients receiving home mechanical ventilation (HMV) has dramatically increased in recent years. Although physiological parameters, health-related quality of life and long-term outcomes frequently serve as primary outcomes, only a few studies have primarily addressed sleep quality in patients undergoing HMV. Therefore, this review article summarizes the current knowledge on sleep quality in patients receiving HMV. RECENT FINDINGS HMV can be performed noninvasively via face masks or invasively via tracheal cannulas. Studies in patients receiving invasive HMV therapy are clearly lacking. Most studies in this field have focused on invasively ventilated patients in the ICU, but the findings are not necessarily applicable to patients undergoing invasive HMV. On the other hand, there are several trials showing that noninvasive ventilation (NIV) has the potential to improve sleep quality in patients with severe sleep disturbances associated with chronic hypercapnic respiratory failure. To this end, both subjectively and objectively assessed sleep qualities by polysomnography are reported to improve after long-term NIV is initiated. SUMMARY Although HMV has the potential to improve sleep quality in patients with chronic hypercapnic respiratory failure, it can also have a negative impact on sleep quality, particularly in cases of patient-ventilator asynchrony or leakage. Therefore, both subjective and objective polysomnographic assessments of sleep quality should become an integral part of managing patients who receive HMV therapy.
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26
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Naik RD, Gupta K, Soneja M, Elavarasi A, Sreenivas V, Sinha S. Sleep Quality and Quantity in Intensive Care Unit Patients: A Cross-sectional Study. Indian J Crit Care Med 2018; 22:408-414. [PMID: 29962740 PMCID: PMC6020640 DOI: 10.4103/ijccm.ijccm_65_18] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Lack of restorative sleep and altered sleep-wake cycle is a frequent problem among patients admitted to the Intensive Care Unit (ICU). This study was conducted to estimate the prevalence of poor sleep and patient's perspective of factors governing poor sleep in the ICU. Materials and Methods: A cross-sectional study was performed in medical ICU of a tertiary care hospital. A total of 32 patients admitted to the ICU for at least 24 h were recruited. A 72-h actigraphy was done followed by a subjective assessment of sleep quality by the Richards-Campbell Sleep Questionnaire (RCSQ). Patient's perspective of sleep quality and quantity and possible risk factors for poor sleep were recorded. Results: Poor sleep (defined as RCSQ <50, sensitivity 88% and specificity 87%) was found in 15 out of the 32 patients (47%). The prevalence of poor sleep was higher among patients on mechanical ventilation (n = 15) (66.7% vs. 33.3%, P < 0.05). Patients with poor sleep had higher age (median age [in years] 42.8 vs. 31.4, P = 0.008), acute physiology, and chronic health evaluation II score (mean 14 ± 5.15 vs. 9.3 ± 5.64, P = 0.02), SAPS 3 score (62.7 ± 8.9 vs. 45.6 ± 10.5, P ≤ 0.0001), and worse actigraphy parameters. Only 55.63% of total sleep time was in the night (2200–0600). All patients had discomfort from indwelling catheters and suctioning of endotracheal tubes. All patients suggested that there be a minimum interruption in the sleep for interventions or medications. Conclusion: There is a high prevalence of poor sleep among patients admitted to the ICU. There is a dire need to minimize untimely interventions and design nonpharmacological techniques to allow patients to sleep comfortably.
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Affiliation(s)
- Ramavath Devendra Naik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.,Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arunmozhimaran Elavarasi
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.,Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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27
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Circadian disruption of ICU patients: A review of pathways, expression, and interventions. J Crit Care 2017; 38:269-277. [DOI: 10.1016/j.jcrc.2016.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
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28
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Huttmann SE, Wilms K, Hamm C, Magnet FS, Windisch W, Storre JH. Assessment of Sleep in Patients Receiving Invasive Mechanical Ventilation in a Specialized Weaning Unit. Lung 2017; 195:361-369. [PMID: 28258358 DOI: 10.1007/s00408-017-9988-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A restful sleep is essential for regenerative processes and remains crucial for patients recovering from stressful periods in the intensive care unit. The current study aimed to assess sleep quality in critically ill patients receiving invasive mechanical ventilation within a specialized weaning unit in hospital. METHODS Tracheotomized subjects undergoing prolonged weaning from mechanical ventilation were included in the study. Polysomnography and gas exchange monitoring was performed during nocturnal ventilation. Subjective evaluation of sleep quality and health-related quality of life were also assessed. RESULTS Nineteen subjects completed the study protocol. Sleep architecture was highly heterogeneous across individual subjects. Mean total sleep time (TST) was 273 ± 114 min, sleep efficacy 70 ± 23%, slow-wave sleep 25.7 ± 18.4%/TST, rapid eye movement sleep 9.6 ± 7.5%/TST, and arousal index 18.7 ± 12.4/h. No significant difference in sleep quality was found between subjects with successful (N = 7) or unsuccessful (N = 12) weaning. Bicarbonate levels were negatively correlated both with sleep efficacy and sleep quality, that latter of which was subjectively assessed by the subjects using a visual analogue scale. CONCLUSION Subjects who were undergoing prolonged weaning from mechanical ventilation and admitted to a specialized weaning unit, showed reduced sleep quality with preservation of high amounts of slow-wave sleep.
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Affiliation(s)
- Sophie Emilia Huttmann
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Katharina Wilms
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Christine Hamm
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Friederike Sophie Magnet
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Jan Hendrik Storre
- Department of Pneumology, Cologne-Merheim Hospital, Kliniken der Stadt Koeln gGmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany.
- Department of Pneumology, University Medical Hospital, Freiburg, Germany.
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Boyko Y, Jennum P, Toft P. Sleep quality and circadian rhythm disruption in the intensive care unit: a review. Nat Sci Sleep 2017; 9:277-284. [PMID: 29184454 PMCID: PMC5689030 DOI: 10.2147/nss.s151525] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients.
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Affiliation(s)
- Yuliya Boyko
- Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, Denmark
| | - Palle Toft
- Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
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Timing of light exposure affects mood and brain circuits. Transl Psychiatry 2017; 7:e1017. [PMID: 28140399 PMCID: PMC5299389 DOI: 10.1038/tp.2016.262] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 12/27/2022] Open
Abstract
Temporal organization of physiology is critical for human health. In the past, humans experienced predictable periods of daily light and dark driven by the solar day, which allowed for entrainment of intrinsic circadian rhythms to the environmental light-dark cycles. Since the adoption of electric light, however, pervasive exposure to nighttime lighting has blurred the boundaries of day and night, making it more difficult to synchronize biological processes. Many systems are under circadian control, including sleep-wake behavior, hormone secretion, cellular function and gene expression. Circadian disruption by nighttime light perturbs those processes and is associated with increasing incidence of certain cancers, metabolic dysfunction and mood disorders. This review focuses on the role of artificial light at night in mood regulation, including mechanisms through which aberrant light exposure affects the brain. Converging evidence suggests that circadian disruption alters the function of brain regions involved in emotion and mood regulation. This occurs through direct neural input from the clock or indirect effects, including altered neuroplasticity, neurotransmission and clock gene expression. Recently, the aberrant light exposure has been recognized for its health effects. This review summarizes the evidence linking aberrant light exposure to mood.
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Abstract
The intensive care unit (ICU) environment is not propitious for restoring sleep and many studies have reported that critically ill patients have severe sleep disruptions. However, sleep alterations in critically ill patients are specific and differ significantly from those in ambulatory patients. Polysomnographic patterns of normal sleep are frequently lacking in critically ill patients and the neurobiology of sleep is important to consider regarding alternative methods to quantify sleep in the ICU. This article discusses elements of sleep neurobiology affecting the specificity of sleep patterns and sleep alterations in patients admitted to the ICU.
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Affiliation(s)
- Xavier Drouot
- CHU de Poitiers, Department of Clinical Neurophysiology, Hôpital Jean Bernard, 2 rue de la Milétrie, Poitiers 86000, France; Univ Poitiers, University of Medicine and Pharmacy, 6 rue de la Milétrie, Poitiers 86000, France; INSERM, CIC 1402, Equipe Alive, CHU de Poitiers, Cours Est J. Bernard, Poitiers 86000, France.
| | - Solene Quentin
- CHU de Poitiers, Department of Clinical Neurophysiology, Hôpital Jean Bernard, 2 rue de la Milétrie, Poitiers 86000, France; Univ Poitiers, University of Medicine and Pharmacy, 6 rue de la Milétrie, Poitiers 86000, France; INSERM, CIC 1402, Equipe Alive, CHU de Poitiers, Cours Est J. Bernard, Poitiers 86000, France
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Dhooria S, Sehgal IS, Agrawal AK, Agarwal R, Aggarwal AN, Behera D. Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature. Indian J Crit Care Med 2016; 20:323-31. [PMID: 27390455 PMCID: PMC4922284 DOI: 10.4103/0972-5229.183908] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge. Materials and Methods: In this prospective, observational study, consecutive patients with ARDS discharged from the Intensive Care Unit (ICU) underwent evaluation with Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and overnight polysomnography. Patients having one or more of the following characteristics were classified as having abnormal sleep: ESS>10, PSQI>5, FOSQ <17.9, apnea–hypopnea index (AHI) ≥5, or AHI during rapid eye movement (REM) sleep ≥5. Results: Twenty patients (median interquartile range [IQR] age of 24 [22–28] years, 11 [55%] females) were included in the study. Acute febrile illness of unknown etiology with multi-organ dysfunction syndrome was the most common underlying etiology for ARDS. The median (IQR) PaO2/FiO2 ratio and APACHE II scores on admission were 176 (151–191.5) and 14 (14–16), respectively. The median (IQR) duration of stay in the ICU was 10 days (7.3–19.5). The overall sleep efficiency (median [IQR], 54% [32.3–65.4%]) was poor. None of the patients had ESS>10, seven (35%) had global PSQI>5 and one had FOSQ <17.9. Ten (50%) patients had at least one characteristic that suggested abnormal sleep (4 insomnia, 2 central sleep apnea, 1 obstructive sleep apnea, 1 REM-SDB, and 2 with a high PSQI, but no specific sleep abnormality). Conclusions: Sleep disturbances are common in ARDS survivors early after discharge from the ICU.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anshu Kumar Agrawal
- Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
The intensive care unit (ICU) environment is not propitious for restoring sleep and many studies have reported that critically ill patients have severe sleep disruptions. However, sleep alterations in critically ill patients are specific and differ significantly from those in ambulatory patients. Polysomnographic patterns of normal sleep are frequently lacking in critically ill patients and the neurobiology of sleep is important to consider regarding alternative methods to quantify sleep in the ICU. This article discusses elements of sleep neurobiology affecting the specificity of sleep patterns and sleep alterations in patients admitted to the ICU.
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Affiliation(s)
- Xavier Drouot
- CHU de Poitiers, Department of Clinical Neurophysiology, Hôpital Jean Bernard, 2 rue de la Milétrie, Poitiers 86000, France; Univ Poitiers, University of Medicine and Pharmacy, 6 rue de la Milétrie, Poitiers 86000, France; INSERM, CIC 1402, Equipe Alive, CHU de Poitiers, Cours Est J. Bernard, Poitiers 86000, France.
| | - Solene Quentin
- CHU de Poitiers, Department of Clinical Neurophysiology, Hôpital Jean Bernard, 2 rue de la Milétrie, Poitiers 86000, France; Univ Poitiers, University of Medicine and Pharmacy, 6 rue de la Milétrie, Poitiers 86000, France; INSERM, CIC 1402, Equipe Alive, CHU de Poitiers, Cours Est J. Bernard, Poitiers 86000, France
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Rittayamai N, Wilcox E, Drouot X, Mehta S, Goffi A, Brochard L. Positive and negative effects of mechanical ventilation on sleep in the ICU: a review with clinical recommendations. Intensive Care Med 2016; 42:531-541. [PMID: 26759012 DOI: 10.1007/s00134-015-4179-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/06/2015] [Indexed: 01/03/2023]
Abstract
PURPOSE Sleep is an essential physiologic process that helps to restore normal body homeostasis. Sleep disturbances have been shown to be associated with poor clinical outcomes, such as a greater risk of cardiovascular disease and increasing mortality. Critically ill patients, particularly those receiving mechanical ventilation, may be more susceptible to sleep disruption. METHODS AND RESULTS Mechanical ventilation is an important factor influencing sleep in critically ill patients as it may have positive or negative effects, depending on patient population, mode, and specific settings. Other causes of sleep disruption include the acute illness itself, the daily routine care, and the effects of medications. Improving sleep in patients admitted to an intensive care unit has the potential to improve both short- and long-term clinical outcomes. In this article we review the specific aspects of sleep in critically ill mechanically ventilated patients, including abnormal sleep patterns and loss of circadian rhythm, as well as the effects of mechanical ventilation and intravenous sedatives on sleep quality and quantity. CONCLUSIONS We provide recommendations for clinicians regarding optimal ventilatory settings and discuss fields for future research.
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Affiliation(s)
- Nuttapol Rittayamai
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.,Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada
| | - Xavier Drouot
- CHU de Poitiers, Service de Neurophysiologie Clinique, Poitiers, France.,Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.,INSERM CIC 1402, Poitiers, France
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, Toronto, Canada.
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Ritmala-Castren M, Virtanen I, Leivo S, Kaukonen KM, Leino-Kilpi H. Sleep and nursing care activities in an intensive care unit. Nurs Health Sci 2015; 17:354-61. [PMID: 25786544 DOI: 10.1111/nhs.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 12/20/2022]
Abstract
This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.
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Affiliation(s)
- Marita Ritmala-Castren
- Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Irina Virtanen
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland
| | - Sanna Leivo
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland
| | - Kirsi-Maija Kaukonen
- Department of Anesthesiology and Intensive Care, Helsinki University Central Hospital, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Hospital District of Southwest Finland, Turku, Finland
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Drouot X, Bridoux A, Thille AW, Roche-Campo F, Cordoba-Izquierdo A, Katsahian S, Brochard L, d'Ortho MP. Sleep continuity: a new metric to quantify disrupted hypnograms in non-sedated intensive care unit patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:628. [PMID: 25420997 PMCID: PMC4271438 DOI: 10.1186/s13054-014-0628-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/29/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Sleep in intensive care unit (ICU) patients is severely altered. In a large proportion of critically ill patients, conventional sleep electroencephalogram (EEG) patterns are replaced by atypical sleep. On the other hand, some non-sedated patients can display usual sleep EEG patterns. In the latter, sleep is highly fragmented and disrupted and conventional rules may not be optimal. We sought to determine whether sleep continuity could be a useful metric to quantify the amount of sleep with recuperative function in critically ill patients with usual sleep EEG features. METHODS We retrospectively reanalyzed polysomnographies recorded in non-sedated critically ill patients requiring non-invasive ventilation (NIV) for acute hypercapnic respiratory failure. Using conventional rules, we built two-state hypnograms (sleep and wake) and identified all sleep episodes. The percentage of time spent in sleep bouts (<10 minutes), short naps (>10 and <30 minutes) and long naps (>30 minutes) was used to describe sleep continuity. In a first study, we compared these measures regarding good (NIV success) or poor outcome (NIV failure). In a second study performed on a different patient group, we compared these measurements during NIV and during spontaneous breathing. RESULTS While fragmentation indices were similar in the two groups, the percentage of total sleep time spent in short naps was higher and the percentage of sleep time spent in sleep bouts was lower in patients with successful NIV. The percentage of total sleep time spent in long naps was higher and the percentage of sleep time spent in sleep bouts was lower during NIV than during spontaneous breathing; the level of reproducibility of sleep continuity measures between scorers was high. CONCLUSIONS Sleep continuity measurements could constitute a clinically relevant and reproducible assessment of sleep disruption in non-sedated ICU patients with usual sleep EEG.
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Subjective sleep quality in stable neuromuscular patients under non-invasive ventilation. Sleep Med 2014; 15:1259-63. [DOI: 10.1016/j.sleep.2014.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/07/2014] [Accepted: 06/05/2014] [Indexed: 11/22/2022]
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Nurses perceptions of sleep in the intensive care unit environment: A literature review. Intensive Crit Care Nurs 2014; 30:231-5. [DOI: 10.1016/j.iccn.2013.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/28/2013] [Accepted: 12/17/2013] [Indexed: 11/23/2022]
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Pulak LM, Jensen L. Sleep in the Intensive Care Unit. J Intensive Care Med 2014; 31:14-23. [DOI: 10.1177/0885066614538749] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 03/13/2014] [Indexed: 01/05/2023]
Abstract
Patients in the intensive care unit (ICU) are susceptible to sleep deprivation. Disrupted sleep is associated with increased morbidity and mortality in the critically ill patients. The etiology of sleep disruption is multifactorial. The article reviews the literature on sleep in the ICU, the effects of sleep deprivation, and strategies to promote sleep in the ICU. Until the impact of disrupted sleep is better explained, it is appropriate to provide critically ill patients with consolidated, restorative sleep.
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Affiliation(s)
- Lisa M. Pulak
- NP Medical Assessment Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Louise Jensen
- Faculty of Nursing, University of Alberta, 4-256 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Comparison of sleep quality with mechanical versus spontaneous ventilation during weaning of critically III tracheostomized patients. Crit Care Med 2013; 41:1637-44. [PMID: 23507721 DOI: 10.1097/ccm.0b013e318287f569] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In mechanically ventilated patients under mechanical ventilation in the ICU, ventilatory mode or settings may influence sleep quality. The aim of this study was to evaluate the direct impact of mechanical ventilation per se on sleep quantity and quality in patients who were able to tolerate separation from mechanical ventilation over prolonged periods. DESIGN AND SETTING Randomized crossover clinical trial in a medical ICU. PATIENTS Sixteen conscious patients, free of sedation and tracheostomized because of prolonged weaning from mechanical ventilation, were included in the study when able to tolerate at least 5 hours of spontaneous ventilation. INTERVENTIONS Patients were randomized to receive either spontaneous ventilation or mechanical ventilation at low levels of pressure support for two crossover periods of 5-hour duration each, from 22:00 to 08:00. Polysomnography was performed throughout the study. MEASUREMENTS AND RESULTS Total sleep time was higher during mechanical ventilation than during spontaneous ventilation (183 min vs 132 min, p = 0.04). No significant differences between mechanical ventilation and spontaneous ventilation were observed in slow wave sleep time (45 min vs 28 min), rapid eye movement sleep time (11 min vs 3 min), or the fragmentation index (25 vs 23 arousals and awakenings per hr). In four patients, however, our analysis of patient-ventilator interaction suggested that the ventilatory settings were suboptimal and could have been improved to potentially improve sleep. CONCLUSIONS In difficult-to-wean tracheostomized patients, sleep quality was similar with or without the ventilator. Sleep quantity was higher during mechanical ventilation. Reconnection to the ventilator during the night period may favor sleep efficiency in tracheostomized patients in prolonged weaning.
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Sleep in hypercapnic critical care patients under noninvasive ventilation: conventional versus dedicated ventilators. Crit Care Med 2013; 41:60-8. [PMID: 23222258 DOI: 10.1097/ccm.0b013e31826764e3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare sleep quality between two types of ventilators commonly used for noninvasive ventilation: conventional ICU ventilators and dedicated noninvasive ventilators; and to evaluate sleep during and between noninvasive ventilation sessions in critically ill patients. DESIGN Physiological sleep study with a randomized assessment of the ventilator type. SETTING Medical ICU in a university hospital. PATIENTS Twenty-four patients admitted for acute hypercapnic respiratory failure requiring noninvasive ventilation. INTERVENTIONS Patients were randomly assigned to receive noninvasive ventilation with either an ICU ventilators (n = 12) or a dedicated noninvasive ventilators (n = 12), and their sleep and respiratory parameters were recorded by polysomnography from 4 PM to 9 AM on the second, third, or fourth day after noninvasive ventilation initiation. MEASUREMENTS AND MAIN RESULTS Sleep architecture was similar between ventilator groups, including sleep fragmentation (number of arousals and awakenings/hr), but the dedicated noninvasive ventilators group showed a higher patient-ventilator asynchrony-related fragmentation (28% [17-44] vs. 14% [7.0-22]; p = 0.02), whereas the ICU ventilators group exhibited a higher noise-related fragmentation. Ineffective efforts were more frequent in the dedicated noninvasive ventilators group than in the ICU ventilators group (34 ineffective efforts/hr of sleep [15-125] vs. two [0-13]; p < 0.01), possibly as a result of a higher tidal volume (7.2 mL/kg [6.7-8.8] vs. 5.8 [5.1-6.8]; p = 0.04). More sleep time occurred and sleep quality was better during noninvasive ventilation sessions than during spontaneous breathing periods (p < 0.05) as a result of greater slow wave and rapid eye movement sleep and lower fragmentation. CONCLUSIONS There were no observed differences in sleep quality corresponding to the type of ventilator used despite slight differences in patient-ventilator asynchrony. Noninvasive ventilation sessions did not prevent patients from sleeping; on the contrary, they seem to aid sleep when compared with unassisted breathing.
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Patient-ventilator synchrony and sleep quality with proportional assist and pressure support ventilation. Intensive Care Med 2013; 39:1040-7. [PMID: 23417203 DOI: 10.1007/s00134-013-2850-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine patient-ventilator asynchrony and sleep quality in non-sedated critically ill patients ventilated with proportional assist ventilation with load adjustable gain factors (PAV+) and pressure support (PSV). METHODS This was a randomized crossover physiological study conducted in an adult ICU at a tertiary hospital. Patients who exhibited patient-ventilator asynchrony on PSV were selected. Polysomnography was performed in these patients over 24 h, during which respiratory variables were continuously recorded. During the study period, each patient was randomized to receive alternating 4-h periods of PSV and PAV+ equally distributed during the day and night. Sleep architecture was analyzed manually using predetermined criteria. Patient-ventilator asynchrony was evaluated breath by breath using the flow-time and airway pressure-time waveforms. RESULTS Fourteen patients were studied. The majority (85.7 %) had either acute exacerbation of COPD as admission diagnosis or COPD as comorbidity. During sleep, compared to PSV, PAV+ significantly reduced the patient-ventilator asynchrony events per hour of sleep [5 (1-17) vs. 40 (4-443), p = 0.02, median (25-75th interquartile range)]. Compared to PSV, PAV+ was associated with slightly but significantly greater sleep fragmentation [18.8 (13.1-33.1) versus 18.1 (7.0-22.8) events/h, p = 0.01] and less REM sleep [0.0 % (0.0-8.4) vs. 5.8 % (0.0-21.9), p = 0.02). CONCLUSIONS PAV+ failed to improve sleep in mechanically ventilated patients despite the fact that this mode was associated with better synchrony between the patient and ventilator. These results do not support the hypothesis that patient-ventilator synchrony plays a central role in determining sleep quality in this group of patients.
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Altérations du sommeil en unité de soins intensifs. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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BOYKO Y, ØRDING H, JENNUM P. Sleep disturbances in critically ill patients in ICU: how much do we know? Acta Anaesthesiol Scand 2012; 56:950-8. [PMID: 22404330 DOI: 10.1111/j.1399-6576.2012.02672.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2012] [Indexed: 01/25/2023]
Abstract
Sleep disturbances in the intensive care unit (ICU) seem to lead to development of delirium, prolonged ICU stay, and increased mortality. That is why sufficient sleep is important for good outcome and recovery in critically ill patients. A variety of small studies reveal pathological sleep patterns in critically ill patients including abnormal circadian rhythm, high arousal and awakening index, reduced Slow Wave Sleep, and Rapid Eye Movement sleep. The purpose of this study is to summarise different aspects of sleep-awake disturbances, causes and handling methods in critically ill patients by reviewing the underlying literature. There are no studies of level 1 evidence proving the positive impact of the tested interventions on the critically ill patients' sleep pattern. Thus, disturbed sleep in critically ill patients with all the severe consequences remains an unresolved problem and needs further investigation.
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Affiliation(s)
- Y. BOYKO
- Department of Anaesthesia and Intensive Care; Vejle Hospital; Vejle; Denmark
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