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Alegria L, Brockmann P, Repetto P, Leonard D, Cadiz R, Paredes F, Rojas I, Moya A, Oviedo V, García P, Bakker J. Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU. PLoS One 2023; 18:e0286180. [PMID: 37228142 DOI: 10.1371/journal.pone.0286180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors associated with the ICU environment, such as exposure to inadequate light and noise levels during the day and night or inflexible schedules of daily care activities, have been described as playing an essential role in sleep disturbances. The main objective of this study is to evaluate the impact of the use of a multifaceted environmental control intervention in the ICU on the quantity and quality of sleep, delirium, and post-intensive care neuropsychological impairment in critically ill patients. METHODS This is a prospective, parallel-group, randomized trial in 56 critically ill patients once they are starting to recover from their acute illness. Patients will be randomized to receive a multifaceted intervention of environmental control in the ICU (dynamic light therapy, auditory masking, and rationalization of ICU nocturnal patient care activities) or standard care. The protocol will be applied from enrollment until ICU discharge. Baseline parameters, light and noise levels, polysomnography and actigraphy, daily oscillation of plasma concentrations of Melatonin and Cortisol, and questionnaires for the qualitative evaluation of sleep, will be assessed during the study. In addition, all patients will undergo standardized follow-up before hospital discharge and at 6 months to evaluate neuropsychological impairment. DISCUSSION This study is the first randomized clinical trial in critically ill patients to evaluate the effect of a multicomponent, non-pharmacological environmental control intervention on sleep improvement in ICU patients. The results will provide data about the potential synergistic effects of a combined multi-component environmental intervention in ICU on outcomes in the ICU and long term, and the mechanism of action. TRIAL REGISTRATION ClinicalTrials.gov, NCT. Registered on January 10, 2023. Last updated on 24 Jan 2023.
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Affiliation(s)
- Leyla Alegria
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Brockmann
- Division of Pediatrics, Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Repetto
- School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Douglas Leonard
- School of Design, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Cadiz
- Faculty of Arts, Music Institute, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Electrical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fabio Paredes
- Faculty of Mathematics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Idalid Rojas
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Moya
- Pediatric Sleep Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vanessa Oviedo
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio García
- Department of Health Sciences, School of Kinesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Bakker
- Intensive Care Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, New York, United States of America
- NYU School of Medicine Langone, New York, New York, United States of America
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Chen L, Zheng J, Lv S, Li B, Yang L. Impact of a sleep promotion protocol on off-pump coronary artery bypass graft patients. Nurs Crit Care 2021; 27:214-222. [PMID: 33880854 DOI: 10.1111/nicc.12637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep abnormalities frequently occur in intensive care unit (ICU) patients, and the consequences of sleep abnormalities in patients who undergo off-pump coronary artery bypass graft (OPCABG) surgery are particularly significant. Although many interventions have been reported to improve sleep, few sleep promotion protocols have been designed specifically for patients in cardiac ICUs. AIMS AND OBJECTIVES This study aimed to explore the effects of an evidence-based sleep promotion protocol on patients who underwent OPCABG in a cardiac ICU. DESIGN A quasi-experimental study was conducted in a comprehensive hospital in Shandong province of China. METHODS Overall, 67 participants were recruited (37 in the control group and 30 in the intervention group). An evidence-based sleep promotion protocol was developed by a 10-member interprofessional collaborative team and then applied. Sound levels, light intensity, and the number of nocturnal interventions were compared between groups. The Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) was used to compare intergroup sleep status on two consecutive postoperative nights. RESULTS No significant differences were found for demographics or disease severity between the groups. In the intervention group, sound levels and light intensity were significantly lower at various times, and nocturnal interventions were significantly less frequent over the two consecutive nights. RCSQ scores were significantly higher in the intervention group for both nights. CONCLUSIONS The sleep promotion protocol reduced sound levels, night-time light intensity, the number of nocturnal interventions, and improved sleep among OPCABG patients in a cardiac ICU. RELEVANCE TO CLINICAL PRACTICE Evidence-based practice can help to promote good quality of care, improve patient outcomes, and advance nursing in clinical settings.
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Affiliation(s)
- Lin Chen
- CCU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Zheng
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shanshan Lv
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Baobao Li
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lijuan Yang
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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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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