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Cunanan B, Muppa H, Orellana L, Bates S, McGain F. Blood gas sampling in the intensive care unit: A prospective before-and-after interventional study on the effect of an educational program on blood gas testing frequency. Aust Crit Care 2024; 37:755-760. [PMID: 38580484 DOI: 10.1016/j.aucc.2024.01.009] [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: 07/21/2023] [Revised: 12/11/2023] [Accepted: 01/20/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Blood gas analysis is the most commonly ordered test in the intensive care unit. Each investigation, however, comes with risks and costs to the patient and healthcare system. Evidence suggests that many tests are performed with no appropriate clinical indication. OBJECTIVES The primary aim of our prospective interventional study was to investigate the proportion of blood gases undertaken with a valid clinical indication before and after an educational intervention. A secondary aim was to examine sleep interruption secondary to blood gas sampling. METHODS A prospective, before-and-after interventional study was conducted across two metropolitan intensive care units in Melbourne, Australia. Adults aged ≥18 years who were admitted to intensive care were eligible for inclusion. Two observation periods were conducted across a 2-week period in May and September 2022 (Periods 1 and 2), where clinicians were encouraged to record the purpose of blood gas sampling and other relevant data via an electronic questionnaire. These data were reviewed with corresponding electronic medical records. In between these periods, an interventional educational program to inform the clinical rationale for blood gas testing was delivered during July and August 2022, including introduction of a clinical guideline. RESULTS There were 68 patients with 688 tests included in Period 1 compared to 69 patients with 756 tests in Period 2. There was no significant difference between the median number of blood gas analyses performed per patient before and after the educational intervention (6.0 tests per patient vs 5.0 tests per patient, p = 0.609). However, there was a significant increase in the percentage of tests with a valid clinical indication (49.0% vs 59.7%, p = 0.0025). The most common indications selected were routine measurement, monitoring a clinical value, change in ventilator settings/oxygen therapy, and clinical deterioration. In addition, there were a large number of patients who were awakened upon drawing of a blood sample for analysis (26.1% for Period 1 and 37.6% for Period 2, p = 0.06). CONCLUSION The implementation of an educational program resulted in a significant increase in the proportion of blood gases performed with an appropriate clinical indication. There was, however, no reduction in the overall number of blood gases performed.
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Affiliation(s)
- Benjamin Cunanan
- Department of Intensive Care, Western Health, Footscray, Victoria, Australia.
| | - Haindavi Muppa
- Department of Intensive Care, Western Health, Footscray, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Footscray, Victoria, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Forbes McGain
- Department of Intensive Care, Western Health, Footscray, Victoria, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
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Farag HI, Murphy BA, Templeman JR, Hanlon C, Joshua J, Koch TG, Niel L, Shoveller AK, Bedecarrats GY, Ellison A, Wilcockson D, Martino TA. One Health: Circadian Medicine Benefits Both Non-human Animals and Humans Alike. J Biol Rhythms 2024; 39:237-269. [PMID: 38379166 PMCID: PMC11141112 DOI: 10.1177/07487304241228021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Circadian biology's impact on human physical health and its role in disease development and progression is widely recognized. The forefront of circadian rhythm research now focuses on translational applications to clinical medicine, aiming to enhance disease diagnosis, prognosis, and treatment responses. However, the field of circadian medicine has predominantly concentrated on human healthcare, neglecting its potential for transformative applications in veterinary medicine, thereby overlooking opportunities to improve non-human animal health and welfare. This review consists of three main sections. The first section focuses on the translational potential of circadian medicine into current industry practices of agricultural animals, with a particular emphasis on horses, broiler chickens, and laying hens. The second section delves into the potential applications of circadian medicine in small animal veterinary care, primarily focusing on our companion animals, namely dogs and cats. The final section explores emerging frontiers in circadian medicine, encompassing aquaculture, veterinary hospital care, and non-human animal welfare and concludes with the integration of One Health principles. In summary, circadian medicine represents a highly promising field of medicine that holds the potential to significantly enhance the clinical care and overall health of all animals, extending its impact beyond human healthcare.
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Affiliation(s)
- Hesham I. Farag
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
| | - Barbara A. Murphy
- School of Agriculture and Food Science, University College, Dublin, Ireland
| | - James R. Templeman
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | - Charlene Hanlon
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
- Department of Poultry Science, Auburn University, Auburn, Alabama, USA
| | - Jessica Joshua
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Thomas G. Koch
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Lee Niel
- Department of Pathobiology, University of Guelph, Guelph, ON, Canada
| | - Anna K. Shoveller
- Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada
| | | | - Amy Ellison
- School of Natural Sciences, Bangor University, Bangor, UK
| | - David Wilcockson
- Department of Life Sciences, Aberystwyth University, Aberystwyth, UK
| | - Tami A. Martino
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- Centre for Cardiovascular Investigations, University of Guelph, Guelph, ON, Canada
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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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Viderman D, Nabidollayeva F, Aubakirova M, Yessimova D, Badenes R, Abdildin Y. Postoperative Delirium and Cognitive Dysfunction after General and Regional Anesthesia: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103549. [PMID: 37240655 DOI: 10.3390/jcm12103549] [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: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Perioperative disorders of neurocognitive function are a set of heterogeneous conditions, which include transient post-operative delirium (POD) and more prolonged post-operative cognitive dysfunction (POCD). Since the number of annually performed surgical procedures is growing, we should identify which type of anesthesia is safer for preserving neurocognitive function. The purpose of this study was to compare the effect of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing surgical procedures under general anesthesia and regional anesthesia. Material and methods: We searched for randomized controlled studies, which studied post-operative cognitive outcomes after general and regional anesthesia in the adult patient population. Results: Thirteen articles with 3633 patients: the RA group consisted of 1823 patients, and the GA group of 1810 patients, who were selected for meta-analysis. The overall effect of the model shows no difference between these two groups in terms of risk for post-operative delirium. The result is insensitive to the exclusion of any study. There was no difference between RA and GA in terms of post-operative cognitive dysfunction. Conclusions: There was no statistically significant difference between GA and RA in the incidence of POD. There was no statistically significant difference in the incidence of POCD per-protocol analysis, psychomotor/attention tests (preoperative/baseline, post-operative), memory tests (postoperatively, follow up), mini-mental state examination score 24 h postoperatively, post-operative reaction time three months postoperatively, controlled oral word association test, and digit copying test. There were no differences in the incidence of POCD in general and regional anesthesia at one week postoperatively, three months postoperatively, or total events (one week or three months). The incidence of post-operative mortality also did not differ between two groups.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Kerei and Zhanibek Khandar Str. 5/1, Astana 010000, Kazakhstan
| | - Fatima Nabidollayeva
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Mina Aubakirova
- Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Kerei and Zhanibek Khandar Str. 5/1, Astana 010000, Kazakhstan
| | - Dinara Yessimova
- Department of Biomedical Sciences, Nazarbayev University School of Medicine (NUSOM), Kerei and Zhanibek Khandar Str. 5/1, Astana 010000, Kazakhstan
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain
| | - Yerkin Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
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Liu H, Wei H, Qian S, Liu J, Xu W, Luo X, Fang J, Liu Q, Cai F. Effects of dexmedetomidine on postoperative sleep quality: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol 2023; 23:88. [PMID: 36944937 PMCID: PMC10029163 DOI: 10.1186/s12871-023-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
STUDY OBJECTIVES To assess the effect of dexmedetomidine (DEX) on postoperative sleep quality using polysomnography (PSG) to identify possible interventions for postoperative sleep disturbances. METHODS An electronic search of PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science was conducted from database inception to November 20, 2022. Randomized controlled trials (RCTs) on the effect of DEX administration on postoperative sleep quality using PSG or its derivatives were included. No language restrictions were applied. The sleep efficiency index (SEI), arousal index (AI), percentages of stage N1, N2 and N3 of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were measured in our meta-analysis. RESULTS Five studies, involving 381 participants were included. Administration of DEX significantly improved SEI, lowered AI, decreased the duration of stage N1 sleep and increased the duration of stage N2 sleep compared to placebo groups. There were no significant differences in the duration of stage N3 sleep and REM sleep. DEX administration lowered the postoperative Visual Analogue Scale (VAS) score and improved the Ramsay sedation score with no adverse effect on postoperative delirium (POD). However, high heterogeneity was observed in most of the primary and secondary outcomes. CONCLUSIONS Our study provides support for the perioperative administration of DEX to improve postoperative sleep quality. The optimal dosage and overall effect of DEX on postoperative sleep quality require further investigation using large-scale randomized controlled trials.
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Affiliation(s)
- Huizi Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Hanwei Wei
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Shaojie Qian
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Jintao Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Weicai Xu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Xiaopan Luo
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Junbiao Fang
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Qiaoyan Liu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China
| | - Fang Cai
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, China.
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Gharaibeh B, Al-Absi I, Abuhammad S, Gharaibeh M, Jarrah M. Sleep quality among different classes of heart failure patients in Jordan: A STROBE compliant cross-sectional study. Medicine (Baltimore) 2022; 101:e32069. [PMID: 36482595 PMCID: PMC9726338 DOI: 10.1097/md.0000000000032069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Many researchers emphasize the importance of studying sleep quality among patients with heart failure (HF). Because of the importance of this topic, many studies have been conducted to address the different aspects of sleep-in various populations of patients with HF. The purposes of our study were: to assess the types of disturbances in sleep within the different classes of HF, and to assess whether there were differences in the levels of sleep quality and types of disturbances in sleep within the different classes in non-hospitalized Jordan patients with HF. Data were gathered from 2 cardiac clinics and 2 medical clinics at 3 Jordan hospitals. A minimum sample of 200 people was recruited to participate in this study based on these criteria and factors. The prevalence of low sleep quality and types of disturbances in sleep were increased with the increase in New York Heart Association class. Nearly 3 quarters of the study sample had poor sleep quality 73.5% (n = 147). Using a score of 5 as a cut point, 147 patients with HF in our study sample had poor sleep quality. The most common types in all classes were waking up for urination, waking in the middle of the night or early morning, waking up due to coughing and snoring, and difficulty falling asleep within 30 minutes. However, waking up due to feeling cold or hot were rarely reported in all classes of patients with HF. Poor sleep quality negatively affects the quality of life in patients with HF by decreasing physical cognitive and psychosocial performance in those patients. This is the first study in literature study sleep quality in the different New York Heart Association functional classes.
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Affiliation(s)
- Besher Gharaibeh
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- * Correspondence: Besher Gharaibeh, Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Postal Code 3030, Irbid 22110, Jordan (e-mail: )
| | - Ilham Al-Absi
- Adult Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Monther Gharaibeh
- Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Mohamad Jarrah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Binte Arman SN, Lee YH, Lopez V, Lim SH. Subjective sleep quality among hospitalised adult patients: An observational, cross-sectional study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Inpatient sleep quality is influenced by multiple factors including medical conditions, use of medication and the ward environment. Without adequate rest, detrimental effects on patients’ physical and psychological performances may persist, inhibiting recovery and increasing length of stay. Objective This study examined the sleep quality of adult inpatients and its’ associations with sociodemographic, clinical and environmental factors. Methods An observational study was conducted in the medical wards of an acute care hospital in Singapore from July to December 2018. Patients completed the Pittsburgh Sleep Quality Index (PSQI) to establish baseline sleeping habits and the Richards-Campbell Sleep Questionnaire (RCSQ) to assess perception of sleep quality during hospitalisation. Noise levels were measured using the SL-4023SD sound level meter. Environmental factors affecting sleep were also recorded. Results 52 patients were recruited reported a mean RCSQ score of 5.83 (SD = 2.31) and mean Global PSQI score was 6.06 (SD = 3.33), indicative of poor baseline sleep. The highest mean noise level presented with an average reading of 80 dB, surpassing the WHO recommended noise levels by two times. Subjective sleep quality was not affected by demographic, clinical factors and bed locations. Patients exposed to night lamps reported a reduction in sleep quality ( p = .04). Conclusions Recognising the importance of overall sleep quality and the identification of external factors influencing patients’ sleep quality during hospitalisation is a vital step towards developing successful interventions to promote good sleep hygiene in the general wards of the Asian context.
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Affiliation(s)
| | - Ying Hui Lee
- Nursing Division, Singapore General Hospital, Singapore
| | - Violeta Lopez
- School of Nursing, Hubei University of Medicine, China
| | - Siew Hoon Lim
- Nursing Division, Singapore General Hospital, Singapore
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Guisasola-Rabes M, Solà-Enriquez B, Vélez-Pereira AM, de Nadal M. Noise Levels and Sleep in a Surgical ICU. J Clin Med 2022; 11:jcm11092328. [PMID: 35566455 PMCID: PMC9105004 DOI: 10.3390/jcm11092328] [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: 03/17/2022] [Revised: 04/06/2022] [Accepted: 04/17/2022] [Indexed: 11/16/2022] Open
Abstract
Sleep is disturbed in critically ill patients and is a frequently overlooked complication. The aim of our study is to evaluate the impact of sound levels in our surgical ICU on our patients’ sleep on the first night of admission. The study was performed in a tertiary care university hospital, in a 12-bed surgical ICU. Over a 6-week period, a total of 148 adult, non-intubated and non-sedated patients completed the study. During this six-week period, sound levels were continuously measured using a type II sound level meter. Sleep quality was evaluated using the Richards–Campbell Sleep Questionnaire (RCSQ), which was completed both by patients and nurses on the first morning after admission. A non-significant correlation was found between night sound levels and sleep quality in the overall sample (r = −1.83, 95% CI; −4.54 to 0.88, p = 0.19). After multivariable analysis, a correlation was found between higher sound levels at night and lower RCSQ evaluations (r = −3.92, 95% CI; −7.57 to −0.27, p = 0.04). We found a significant correlation between lower sound levels at night and a better quality of sleep in our patients; for each 1 dBA increase in LAFeq sound levels at night, patients scored 3.92 points lower on the sleep questionnaire.
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Affiliation(s)
- Maria Guisasola-Rabes
- Anaesthesiology Department, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebrón 119-129, 08035 Barcelona, Spain; (B.S.-E.); (M.d.N.)
- Correspondence: ; Tel.: +34-932746004
| | - Berta Solà-Enriquez
- Anaesthesiology Department, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebrón 119-129, 08035 Barcelona, Spain; (B.S.-E.); (M.d.N.)
| | - Andrés M. Vélez-Pereira
- Departamento de Ingeniería Mecánica, Facultad de Ingeniería, Universidad de Tarapacá, Avenue 18 de Septiembre 2222, Arica 1000007, Chile;
| | - Miriam de Nadal
- Anaesthesiology Department, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebrón 119-129, 08035 Barcelona, Spain; (B.S.-E.); (M.d.N.)
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Theuerkauf NU, Putensen C, Schewe JC. [Noise Reduction on the ICU]. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:14-26. [PMID: 35021237 DOI: 10.1055/a-1477-2300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Noise pollution in the intensive care unit is not only an omnipresent but also a considerable problem, both for patients and healthcare staff. There are a number of significant sources of noise that are at least partially responsible for the frequent and serious sleep disorders of intensive care unit patients. This has a negative impact on the recovery of intensive care patients and favours the occurrence of delirium, which can be associated with increased overall mortality. This article provides a summary of the current evidence on the occurrence of noise-associated consequences and possible options for reducing noise exposure in the intensive care unit and offers perspectives for improving treatment of intensive care patients.
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Vassallo P, Novy J, Zubler F, Schindler K, Alvarez V, Rüegg S, Rossetti AO. EEG spindles integrity in critical care adults. Analysis of a randomized trial. Acta Neurol Scand 2021; 144:655-662. [PMID: 34309006 PMCID: PMC9290497 DOI: 10.1111/ane.13510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Occurrence of EEG spindles has been recently associated with favorable outcome in ICU patients. Available data mostly rely on relatively small patients' samples, particular etiologies, and limited variables ascertainment. We aimed to expand previous findings on a larger dataset, to identify clinical and EEG patterns correlated with spindle occurrence, and explore its prognostic implications. METHODS Retrospective observational study of prospectively collected data from a randomized trial (CERTA, NCT03129438) assessing the relationship of continuous (cEEG) versus repeated routine EEG (rEEG) with outcome in adults with acute consciousness impairment. Spindles were prospectively assessed visually as 12-16Hz activity on fronto-central midline regions, at any time during EEG interventions. Uni- and multivariable analyses explored correlations between spindles occurrence, clinical and EEG variables, and outcome (modified Rankin Scale, mRS; mortality) at 6 months. RESULTS Among the analyzed 364 patients, spindles were independently associated with EEG background reactivity (OR 13.2, 95% CI: 3.11-56.26), and cEEG recording (OR 4.35, 95% CI: 2.5 - 7.69). In the cEEG subgroup (n=182), 33.5% had spindles. They had better FOUR scores (p=0.004), fewer seizures or status epilepticus (p=0.02), and lower mRS (p=0.02). Mortality was reduced (p=0.002), and independently inversely associated with spindle occurrence (OR 0.50, CI 95% 0.25-0.99) and increased EEG background continuity (OR 0.16, 95% CI: 0.07 - 0.41). CONCLUSIONS Besides confirming that spindle activity occurs in up to one third of acutely ill patients and is associated with better outcome, this study shows that cEEG has a higher yield than rEEG in identifying them. Furthermore, it unravels associations with several clinical and EEG features in this clinical setting.
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Affiliation(s)
- Paola Vassallo
- Department of Clinical NeuroscienceLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jan Novy
- Department of Clinical NeuroscienceLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Frédéric Zubler
- Sleep – Wake – Epilepsy ‐ CenterDepartment of NeurologyInselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Kaspar Schindler
- Sleep – Wake – Epilepsy ‐ CenterDepartment of NeurologyInselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Vincent Alvarez
- Department of Clinical NeuroscienceLausanne University Hospital and University of LausanneLausanneSwitzerland
- Department of NeurologyHôpital du ValaisSionSwitzerland
| | - Stephan Rüegg
- Department of NeurologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Andrea O. Rossetti
- Department of Clinical NeuroscienceLausanne University Hospital and University of LausanneLausanneSwitzerland
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Nozawa S, Urushihata K, Machida R, Hanaoka M. Sleep architecture of short sleep time in patients with obstructive sleep apnea: a retrospective single-facility study. Sleep Breath 2021; 26:1633-1640. [PMID: 34807406 DOI: 10.1007/s11325-021-02533-7] [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: 06/11/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Sleep architecture consists of rapid eye movement (REM) sleep and non-REM sleep time. Non-REM sleep time is further classified into three stages by depth (stage N1-N3). Some studies have reported that short sleep time predicts all-cause mortality. Short sleep time can have characteristics of sleep architecture which contribute to poor prognosis. Obstructive sleep apnea (OSA) is a disease which causes cessation or decline of ventilation during sleep due to upper airway stenosis and affects sleep architecture. Few studies have reported on the sleep architecture of short sleep time in patients with OSA. Therefore, we aimed to observe this phenomenon. METHODS From May 2008 to September 2021, patients diagnosed with OSA at our facility were assessed for clinical history and underwent full-night polysomnography (PSG). These patients were classified into two groups: total sleep time (TST) recorded on PSG consisting of a short TST (< 7 h) group and a not short TST (≥ 7 h) group. RESULTS Of 266 patients with OSA, compared to the not short TST group (n = 131), the short TST group (n = 135) had a lower REM sleep time (%) and a higher stage N1 sleep time (%). There was a significant difference in age between the two groups, so sub-analyses classified the patients by age: non-elderly patients (< 65 years) and elderly patients (≥ 65 years) to adjust for age. Both sub-analyses showed similar results to the analysis for the combined ages regarding sleep architecture. CONCLUSION Patients with OSA who had short sleep time had disordered sleep architecture with a lower REM sleep time (%) and more stage N1 sleep time.
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Affiliation(s)
- Shuhei Nozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan.
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Ryosuke Machida
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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Darby A, Northam K, Austin CA, Chang L, Campbell-Bright S. Development and Implementation of a Multicomponent Protocol to Promote Sleep and Reduce Delirium in a Medical Intensive Care Unit. Ann Pharmacother 2021; 56:645-655. [PMID: 34490790 DOI: 10.1177/10600280211043278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients. OBJECTIVE To assess the impact of implementing a multicomponent sleep protocol. METHODS In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality. RESULTS The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; P = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; P = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; P = 0.95), and in-hospital mortality (16.7% vs 17.9%, P = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; P = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; P = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness. CONCLUSIONS AND RELEVANCE This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.
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Affiliation(s)
- Adrienne Darby
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Kalynn Northam
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | - Lydia Chang
- University of North Carolina, Chapel Hill, NC, USA
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2021; 45:470-476. [PMID: 34456175 DOI: 10.1016/j.medine.2021.08.011] [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: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, Spain
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
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Sundstrøm M, Sverresvold C, Trygg Solberg M. Factors contributing to poor sleep in critically ill patients: A systematic review and meta-synthesis of qualitative studies. Intensive Crit Care Nurs 2021; 67:103108. [PMID: 34247939 DOI: 10.1016/j.iccn.2021.103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the causes of poor sleep in critically ill patients from nurses' experiences. REVIEW METHODOLOGY A meta-synthesis following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was conducted. Articles were searched systematically in the CINAHL, MEDLINE and Embase databases up to January 2020. Study selection and data extraction were performed by two authors working independently. Included articles were critically evaluated by both authors using the Critical Appraisal Screening Programme tool. FINDINGS The meta-synthesis resulted in four analytical themes: (1) Inherent factors of critical illness, (2) Lack of implementation of evidence-based practice, (3) Lack of relational collaboration, (4) Hospital organisation and culture. CONCLUSION This literature review indicates that promoting critically ill patients' sleep is difficult. Evidence-based interventions should be implemented into practice in order for nurses to be able to meet the patients' needs and improve sleep. Furthermore, the team surrounding the patient must have support from the health care organisation, and a culture change is necessary to improve communication between them to reach a shared goal to improve critically ill patients' sleep.
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Affiliation(s)
- Maria Sundstrøm
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway; Oslo University Hospital, Oslo, Norway.
| | - Camilla Sverresvold
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway; Oslo University Hospital, Oslo, Norway.
| | - Marianne Trygg Solberg
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway.
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15
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Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units: Patients' perceptions. Nurs Crit Care 2021; 27:195-203. [PMID: 33949036 DOI: 10.1111/nicc.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels. AIMS AND OBJECTIVES To assess the stressors affecting patients admitted to ICCUs. DESIGN This is a cross-sectional study performed in a public hospital in São Paulo, Brazil. METHODS A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests. RESULTS Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control." CONCLUSIONS Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions. RELEVANCE TO CLINICAL PRACTICE Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.
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Affiliation(s)
- Aluê Constantino Coelho
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Vinicius Batista Santos
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
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The Impact of Earplugs and Eye Masks on Sleep Quality in Surgical ICU Patients at Risk for Frequent Awakenings. Crit Care Med 2021; 49:e822-e832. [PMID: 33870919 DOI: 10.1097/ccm.0000000000005031] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings. DESIGN Prospective randomized controlled trial. SETTING Surgical ICU within the University of Texas Southwestern Medical Center. PATIENTS Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019. INTERVENTIONS Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care. MEASUREMENTS AND MAIN RESULTS The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group's average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8-53.8), the intervention group's average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3-70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores. CONCLUSIONS These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.
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Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and Management of Delirium in the Intensive Care Unit. Semin Respir Crit Care Med 2021; 42:112-126. [PMID: 32746469 PMCID: PMC7855536 DOI: 10.1055/s-0040-1710572] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Delirium is a debilitating form of brain dysfunction frequently encountered in the intensive care unit (ICU). It is associated with increased morbidity and mortality, longer lengths of stay, higher hospital costs, and cognitive impairment that persists long after hospital discharge. Predisposing factors include smoking, hypertension, cardiac disease, sepsis, and premorbid dementia. Precipitating factors include respiratory failure and shock, metabolic disturbances, prolonged mechanical ventilation, pain, immobility, and sedatives and adverse environmental conditions impairing vision, hearing, and sleep. Historically, antipsychotic medications were the mainstay of delirium treatment in the critically ill. Based on more recent literature, the current Society of Critical Care Medicine (SCCM) guidelines suggest against routine use of antipsychotics for delirium in critically ill adults. Other pharmacologic interventions (e.g., dexmedetomidine) are under investigation and their impact is not yet clear. Nonpharmacologic interventions thus remain the cornerstone of delirium management. This approach is summarized in the ABCDEF bundle (Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment). The implementation of this bundle reduces the odds of developing delirium and the chances of needing mechanical ventilation, yet there are challenges to its implementation. There is an urgent need for ongoing studies to more effectively mitigate risk factors and to better understand the pathobiology underlying ICU delirium so as to identify additional potential treatments. Further refinements of therapeutic options, from drugs to rehabilitation, are current areas ripe for study to improve the short- and long-term outcomes of critically ill patients with delirium.
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Affiliation(s)
- Matthew F. Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Bioengineering, Vanderbilt University, Nashville, Tennessee
| | - Barbara Salas
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Pratik P. Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee
- Division of Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, Tennessee
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee
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18
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Czempik PF, Jarosińska A, Machlowska K, Pluta MP. Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study. Sci Rep 2020; 10:19207. [PMID: 33154537 PMCID: PMC7644698 DOI: 10.1038/s41598-020-76314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/27/2020] [Indexed: 01/28/2023] Open
Abstract
Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 14 Medyków Str., 40-752, Katowice, Poland.
| | - Agnieszka Jarosińska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krystyna Machlowska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał P Pluta
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Koh AP, van Schie T, Park Y, Kalantari S. Electroencephalography Data-Driven Lighting System to Improve Sleep Quality in Intensive Care Unit Patients: A Case Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4294-4297. [PMID: 33018945 DOI: 10.1109/embc44109.2020.9176514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sleep disturbance and deprivation are major factors in delayed recovery, which can affect both the physical and emotional well-being of patients. Patients hospitalized in the Intensive Care Unit (ICU) are especially vulnerable to sleep deprivation due to light-induced disturbances. A desirable lighting intervention in the ICU would minimize light-induced disturbances while simultaneously providing feedback for the staff on when to perform patient care activities that require high intensity lighting. To this end, we performed a first phase testing for a biometrics-integrated lighting system that serves a dual function of sleep initiation and maintenance to improve the patient's quality of sleep. Preliminary findings are presented as a case study to assess the feasibility of scaling up the experimental model. While findings point to additional testing being necessary to determine whether the lighting system will be effective, the experiment detailed in this report establishes a starting paradigm upon which to base further investigation.Clinical Relevance- A biometrics-integrated lighting system that can improve sleep quality of the patient will not only reduce cost of care for the patients, but also increase the level of satisfaction for both patients and the hospital staff.
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20
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Al-Sulami GS, Rice AM, Kidd L, O'Neill A, Richards KC, McPeake J. An Arabic Translation, Reliability, Validity, and Feasibility of the Richards-Campbell Sleep Questionnaire for Sleep Quality Assessment in ICU: Prospective-Repeated Assessments. J Nurs Meas 2020; 27:E153-E169. [PMID: 31871294 DOI: 10.1891/1061-3749.27.3.e153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To translate Richards-Campbell Sleep Questionnaire (RCSQ) into the Arabic language (RCSQ-A), to assess content validity of the translated tool, to analyze the internal consistency, and to evaluate its feasibility. METHODS A rigorous translation was completed using the process of translation by World Health Organization. Cognitive debriefing interviews were performed. Repeated assessments using RCSQ-A was conducted in critical care patients in Saudi Arabia. RESULT Cronbach's alpha of .89 was seen in the RCSQ-A. The cognitive interviews showed that the RCSQ-A well understood and interpreted correctly and consistently. Fifty-seven participants reported their sleep using RCSQ-A a total of 110 times. CONCLUSION RCSQ-A has adequate translation validity, provided good internal consistency and content validity, making it suitable for use as a measurement tool in practice and research in Arabic-speaking countries.
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Affiliation(s)
- Ghaida S Al-Sulami
- Nursing College, Department of Acute and Critical Care,Umm Al-Qura University, Saudi Arabia.,Nursing & Health Care School, School of Medicine Dentistry and Nursing, University of Glasgow, United Kingdom
| | - Ann Marie Rice
- Nursing & Health Care School, School of Medicine Dentistry and Nursing, University of Glasgow
| | - Lisa Kidd
- Nursing & Health Care School, School of Medicine Dentistry and Nursing, University of Glasgow
| | - Anna O'Neill
- Nursing & Health Care School, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Kathy C Richards
- School of Nursing, University of Texas, Nursing School, Austin, Texas
| | - Joanne McPeake
- Nursing & Health Care School, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
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21
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Zivi P, De Gennaro L, Ferlazzo F. Sleep in Isolated, Confined, and Extreme (ICE): A Review on the Different Factors Affecting Human Sleep in ICE. Front Neurosci 2020; 14:851. [PMID: 32848590 PMCID: PMC7433404 DOI: 10.3389/fnins.2020.00851] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/21/2020] [Indexed: 02/05/2023] Open
Abstract
The recently renewed focus on the human exploration of outer space has boosted the interest toward a variety of questions regarding health of astronauts and cosmonauts. Among the others, sleep has traditionally been considered a central issue. To extend the research chances, human sleep alterations have been investigated in several analog environments, called ICEs (Isolated, Confined, and Extreme). ICEs share different features with the spaceflight itself and have been implemented in natural facilities and artificial simulations. The current paper presents a systematic review of research findings on sleep disturbances in ICEs. We looked for evidence from studies run in polar settings (mostly Antarctica) during space missions, Head-Down Bed-Rest protocols, simulations, and in a few ICE-resembling settings such as caves and submarines. Even though research has shown that sleep can be widely affected in ICEs, mostly evidencing general and non-specific changes in REM and SWS sleep, results show a very blurred picture, often with contradictory findings. The variable coexistence of the many factors characterizing the ICE environments (such as isolation and confinement, microgravity, circadian disentrainment, hypoxia, noise levels, and radiations) does not provide a clear indication of what role is played by each factor per se or in association one with each other in determining the pattern observed, and how. Most importantly, a number of methodological limitations contribute immensely to the unclear pattern of results reported in the literature. Among them, small sample sizes, small effect sizes, and large variability among experimental conditions, protocols, and measurements make it difficult to draw hints about whether sleep alterations in ICEs do exist due to the specific environmental characteristics, and which of them plays a major role. More systematic and cross-settings research is needed to address the mechanisms underlying the sleep alterations in ICE environments and possibly develop appropriate countermeasures to be used during long-term space missions.
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Affiliation(s)
| | | | - Fabio Ferlazzo
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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22
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2020; 45:S0210-5691(20)30114-5. [PMID: 32482371 DOI: 10.1016/j.medin.2020.03.016] [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: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, España
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
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Zhang J, Jin X, Li R, Gao Y, Li J, Wang G. Influence of rapid eye movement sleep on all-cause mortality: a community-based cohort study. Aging (Albany NY) 2020; 11:1580-1588. [PMID: 30867337 PMCID: PMC6428105 DOI: 10.18632/aging.101858] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/06/2019] [Indexed: 12/24/2022]
Abstract
Introduction: Although the proportion and duration of rapid eye movement (REM) sleep are correlated with neurological and cardiovascular diseases, whether REM sleep is associated with all-cause mortality in community-based populations remains unknown. Methods: A prospective study was performed within the Sleep Heart Health Study (SHHS, Registration NO. NCT00005275). Total sleep time, sleep efficiency, and REM sleep were measured using polysomnography. Cox proportional hazards regression models were used to estimate the association of the REM sleep with all-cause mortality. Results: Over a mean follow-up period of 11.0 ± 3.1 y, 1234 individuals (21.9%) died. In the entire population, reduced REM sleep was significantly associated with increasing all-cause mortality. After adjustment for age, sex, race, body mass index, smoking status, total cholesterol, triglycerides, high-density lipoprotein, history of diabetes and hypertension, and the apnea–hypopnea index, the duration and proportion of REM sleep were found to be significantly associated with all-cause mortality when the lowest and the highest REM quartile groups were compared (hazard ratio, 95% confidence interval: 1.727, 1.434-2.079; 1.545, 1.298-1.839; respectively). Conclusion: The proportion and duration of REM sleep are negatively associated with all-cause mortality. This finding emphasizes the importance of personalized sleep management in community-based populations.
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Affiliation(s)
- Jingjing Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Xuting Jin
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ruohan Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Ya Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Jiamei Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Gang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
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Atterton B, Paulino MC, Povoa P, Martin-Loeches I. Sepsis Associated Delirium. ACTA ACUST UNITED AC 2020; 56:medicina56050240. [PMID: 32443606 PMCID: PMC7279289 DOI: 10.3390/medicina56050240] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/04/2023]
Abstract
Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient’s ability to wean from organ support.
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Affiliation(s)
- Ben Atterton
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, St. James Street, Dublin 8, Dublin, D08 NHY1, Ireland;
| | - Maria Carolina Paulino
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, 1449-005 Lisbon, Portugal; (M.C.P.); (P.P.)
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, 1449-005 Lisbon, Portugal; (M.C.P.); (P.P.)
- NOVA Medical School, CHRC, New University of Lisbon, 1099-085 Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, 5000 Odense, Denmark
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, St. James Street, Dublin 8, Dublin, D08 NHY1, Ireland;
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, 08036 Barcelona, Spain
- Correspondence:
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Younis MB, Hayajneh F, Rubbai Y. Factors influencing sleep quality among Jordanian intensive care patients. ACTA ACUST UNITED AC 2020; 29:298-302. [PMID: 32167811 DOI: 10.12968/bjon.2020.29.5.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sleep disturbance is common in patients in the intensive care unit (ICU). Numerous factors can contribute to this. High noise and light levels, nursing interventions and medication administration are major factors. This study investigated the demographic and environmental factors that might adversely affect ICU patients' quality of sleep. Data were collected from 103 patients using a demographic data sheet, the Freedman Quality of Sleep Scale and the Richards-Campbell Sleep Scale. Patients' demographic characteristics were found to have no significant effects on their perceived quality of sleep. Environmental factors, including noise, light, nursing interventions, diagnostic testing, the administration of medication, talking and phones ringing, were significantly related to the patients' perceived quality of sleep.
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Affiliation(s)
- Mohammad Bani Younis
- Assistant Professor, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Feryal Hayajneh
- Professor, Faculty of Nursing, University of Jordan, Amman, Jordan
| | - Yousef Rubbai
- Lecturer, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
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Cooke M, Ritmala-Castrén M, Dwan T, Mitchell M. Effectiveness of complementary and alternative medicine interventions for sleep quality in adult intensive care patients: A systematic review. Int J Nurs Stud 2020; 107:103582. [PMID: 32380262 DOI: 10.1016/j.ijnurstu.2020.103582] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pharmacological interventions for sleep (analgesic, sedative and hypnotic agents) can both disrupt and induce sleep and have many negative side effects within the intensive care population. The use of complementary and alternative medicine therapies to assist with sleep has been studied but given the variety of modalities and methodological limitations no reliable conclusions have been drawn. OBJECTIVE To synthesise research findings regarding the effectiveness of using complementary and alternative medicine interventions within the domains of mind and body practices (relaxation techniques, acupuncture) and natural biologically based products (herbs, vitamins, minerals, probiotics) on sleep quality and quantity in adult intensive care patients. REVIEW METHOD USED Systematic review. DATA SOURCES Five databases were searched in August 2018 and updated in February 2019 and 2020. REVIEW METHODS Searches were limited to peer reviewed randomised controlled trials, published in English involving adult populations in intensive care units. Interventions were related to the complementary and alternative medicine domains of mind and body practices and natural products. Included studies were assessed using Cochrane's risk of bias tool. RESULTS Seventeen studies were included. The interventions used varied: 4 investigated melatonin; 4 music +/- another therapy; 3 acupressure; 2 aromatherapy and 1 each for relaxation and imagery, reflexology, bright light exposure and inspiratory muscle training. Measurement of sleep quantity and quality was also varied: 5 studies used objective measures such as Polysomnography and Bispectral index with the remaining using subjective patient or clinician assessment (for example, Richards-Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index, observation). Given the different interventions, outcomes and measures used in the studies a meta-analysis was not possible. Generally, the results support the use of complementary and alternative medicine for assisting with sleep with 11 out of 17 trials reporting significant results for the interventions examined. CONCLUSIONS Complementary and alternative medicine interventions, in particular, melatonin and music, have shown promise for improving sleep in adults with critical conditions; however, further research that addresses the limitations of small sample sizes and improved techniques for measuring sleep is needed.
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Affiliation(s)
- Marie Cooke
- School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan QLD 4111, Australia.
| | | | - Toni Dwan
- Artius Health, Labrador QLD 4215, Australia
| | - Marion Mitchell
- Nathan Qld 4111. Princess Alexandra Hospital, Department of Emergency Medicine, Ipswich Rd, School of Nursing and Midwifery and Menzies Health Institute Queensland, Griffith University, Wooloongabba, QLD 4102, Australia
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Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2020; 24:33-37. [PMID: 32148346 PMCID: PMC7050169 DOI: 10.5005/jp-journals-10071-23323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Sleep deprivation in the intensive care unit (ICU) has been linked to numerous complications. Light levels might impact the sleep of patients in the ICU. The aim of the study was to measure light levels during sleep-protected time in the ICU and to assess the impact of light intensity on sleep quantity/quality. Materials and methods This prospective, observational study was conducted in a 10-bed, mixed surgical/medical ICU. For measuring light levels, a commercially available smartphone application was used. The measurements were performed between 23:30 and 06:15 hours at 15-minute intervals. To assess sleep quantity, we used Patient's Sleep Observation Behavioral Tool and to assess sleep quality, we used Richards-Campbell Sleep Scale. Results The median number of time points at which patients were asleep was 20 (interquartile range, IQR 14-23) out of 25 (5 hours). The median self-reported quality of sleep (overall score) was 49 (IQR 28-71). The median values for individual questions are: question 1 (sleep depth)-54.0 (IQR 37-78), question 2 (sleep latency)-40.5 (IQR 6-90), question 3 (awakenings)-52.5 (IQR 28-76), question 4 (returning to sleep)-25.5 (IQR 11-78), and question 5 (sleep quality)-67.5 (IQR 5-76). No correlation was found between self-reported sleep quality and time spent asleep (p = 0.36). There was no correlation between average light levels during sleep-protected time and sleep quantity (p = 0.42)/sleep quality (p = 0.13). There was a correlation between average (13 ± 5 lux) light levels before sleep-protected time and sleep quality (p = 0.008). Conclusion Mean light levels of 11 ± 9 lux during sleep-protected time have no negative impact on quantity and quality of sleep in intensive care unit patients. Light levels up to 18 lux directly before falling asleep improve patients' self-reported quality of sleep in the ICU. Clinical significance Finding safe levels of light intensity during sleep-protected time in ICU. How to cite this article Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2020;24(1):33-37.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Jarosińska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krystyna Machlowska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Pluta
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Reinke L, Haveman M, Horsten S, Falck T, van der Heide EM, Pastoor S, van der Hoeven JH, Absalom AR, Tulleken JE. The importance of the intensive care unit environment in sleep-A study with healthy participants. J Sleep Res 2019; 29:e12959. [PMID: 31833118 PMCID: PMC7154670 DOI: 10.1111/jsr.12959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/20/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022]
Abstract
Sleep disruption is common among intensive care unit patients, with potentially detrimental consequences. Environmental factors are thought to play a central role in ICU sleep disruption, and so it is unclear why environmental interventions have shown limited improvements in objectively assessed sleep. In critically ill patients, it is difficult to isolate the influence of environmental factors from the varying contributions of non‐environmental factors. We thus investigated the effects of the ICU environment on self‐reported and objective sleep quality in 10 healthy nurses and doctors with no history of sleep pathology or current or past ICU employment participated. Their sleep at home, in an unfamiliar environment (‘Control’), and in an active ICU (‘ICU’) was evaluated using polysomnography and the Richard‐Campbell Sleep Questionnaire. Environmental sound, light and temperature exposure were measured continuously. We found that the control and ICU environment were noisier and warmer, but not darker than the home environment. Sleep on the ICU was perceived as qualitatively worse than in the home and control environment, despite relatively modest effects on polysomnography parameters compared with home sleep: mean total sleep times were reduced by 48 min, mean rapid eye movement sleep latency increased by 45 min, and the arousal index increased by 9. Arousability to an awake state by sound was similar. Our results suggest that the ICU environment plays a significant but partial role in objectively assessed ICU sleep impairment in patients, which may explain the limited improvement of objectively assessed sleep after environmental interventions.
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Affiliation(s)
- Laurens Reinke
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolein Haveman
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sandra Horsten
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Johannes H van der Hoeven
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anthony R Absalom
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jaap E Tulleken
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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29
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Red light at night permits the nocturnal rise of melatonin production in horses. Vet J 2019; 252:105360. [DOI: 10.1016/j.tvjl.2019.105360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/26/2022]
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30
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Brito RA, do Nascimento Rebouças Viana SM, Beltrão BA, de Araújo Magalhães CB, de Bruin VMS, de Bruin PFC. Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review. Sleep Breath 2019; 24:25-35. [PMID: 31368029 DOI: 10.1007/s11325-019-01902-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. METHODS A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. RESULTS Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. CONCLUSIONS Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.
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Affiliation(s)
| | | | - Beatriz Amorim Beltrão
- Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Pedro Felipe Carvalhedo de Bruin
- Laboratory of Sleep and Biological Rhythms, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Department of Medicine, Federal University of Ceará, Fortaleza, CE, 60430-140, Brazil.
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31
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Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. Med Intensiva 2019; 44:344-350. [PMID: 31178271 DOI: 10.1016/j.medin.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 12/27/2022]
Abstract
AIM A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire. RESULTS Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.
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32
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Hsu WC, Guo SE, Chang CH. Back massage intervention for improving health and sleep quality among intensive care unit patients. Nurs Crit Care 2019; 24:313-319. [PMID: 30942526 DOI: 10.1111/nicc.12428] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A massage may relax muscles, improve blood circulation and reduce pain and anxiety while also improving sleep quality by increasing comfort. However, there is little research on whether a back massage improves sleep quality in intensive care unit (ICU) patients. AIMS AND OBJECTIVES This study examined the effects of a back massage on improving vital signs, sleep quality, anxiety and depression among ICU patients. DESIGN Adopting a quasi-experimental design, convenience sampling was used to recruit ICU patients from a medical centre in Southern Taiwan. The experimental group received back massages for three consecutive days (n = 30), while controls received usual care (n = 30). METHODS The Verran and Snyder-Halpern Scale and the Hospital Anxiety and Depression Scale were used, and subjective and objective sleep time (wrist actigraphy and sleep duration from nurse observations) was recorded. The effect of the intervention was examined using a generalized estimating equation model with a robust standard error and an exchangeable working correlation matrix adjusting for time. RESULTS The results show that subjective sleep quality scores in ICU patients were low. Mean observed sleep time (measured by nurses) was 3·9 h, but mean sleep time measured using wrist actigraphy was 5·9 h. Back massages improved breathing in patients, increased sleep quality reflected by both subjective and objective data and were associated with a significant change in anxiety. CONCLUSIONS These findings suggest that a 10-min back massage can improve sleep quality, sleep duration, breathing and anxiety in ICU patients. RELEVANCE TO CLINICAL PRACTICE The implementation of a back massage shows positive improvements in the sleep quality of ICU patients. The training and theory of massage interventions should be further applied when developing courses in critical care nursing.
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Affiliation(s)
| | - Su-Er Guo
- Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology (CGUST), Puzi, Taiwan.,Chronic Diseases and Health Promotion Research Centre, CGUST, Puzi, Taiwan.,Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Puzi, Taiwan.,Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Chia-Hao Chang
- Graduate Institute of Nursing, College of Nursing, CGUST, Puzi, Taiwan
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33
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Stamenkovic DM, Laycock H, Karanikolas M, Ladjevic NG, Neskovic V, Bantel C. Chronic Pain and Chronic Opioid Use After Intensive Care Discharge - Is It Time to Change Practice? Front Pharmacol 2019; 10:23. [PMID: 30853909 PMCID: PMC6395386 DOI: 10.3389/fphar.2019.00023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/10/2019] [Indexed: 12/12/2022] Open
Abstract
Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33-73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.
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Affiliation(s)
- Dusica M Stamenkovic
- Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia.,Medical Faculty, University of Defense, Belgrade, Serbia
| | - Helen Laycock
- Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Menelaos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Nebojsa Gojko Ladjevic
- Center for Anesthesia, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislava Neskovic
- Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia.,Medical Faculty, University of Defense, Belgrade, Serbia
| | - Carsten Bantel
- Universitätsklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, und Schmerztherapie, Universität Oldenburg, Klinikum Oldenburg, Oldenburg, Germany.,Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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34
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Measurement and Nonpharmacologic Management of Sleep Disturbance in the Intensive Care Units. Crit Care Nurs Q 2019; 42:75-80. [DOI: 10.1097/cnq.0000000000000240] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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35
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Azuma K, Mishima S, Shimoyama K, Ishii Y, Ueda Y, Sakurai M, Morinaga K, Fujikawa T, Oda J. Validation of the Prediction of Delirium for Intensive Care model to predict subsyndromal delirium. Acute Med Surg 2018; 6:54-59. [PMID: 30651998 PMCID: PMC6328902 DOI: 10.1002/ams2.378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/19/2018] [Indexed: 11/08/2022] Open
Abstract
Aim Subsyndromal delirium is associated with prolonged intensive care unit stays, and prolonged mechanical ventilation requirements. The Prediction of Delirium for Intensive Care (PRE‐DELIRIC) model can predict delirium. This study was designed to verify if it can also predict development of subsyndromal delirium. Methods We undertook a single‐center, retrospective observation study in Japan. We diagnosed subsyndromal delirium based on the Intensive Care Delirium Screening Checklist. We calculated the sensitivity and specificity of the PRE‐DELIRIC model and obtained a diagnostic cut‐off value. Results We evaluated data from 70 patients admitted to the mixed medical intensive care unit of the Tokyo Medical University Hospital (Tokyo, Japan) between May 2015 and February 2017. The prevalence of subsyndromal delirium by Intensive Care Delirium Screening Checklist was 31.4%. The area under the receiver operating characteristic curve was 0.83 of the PRE‐DELIRIC model for subsyndromal delirium. The calculated cut‐off value was 36 points with a sensitivity of 94.3% and specificity of 57.1%. Subsyndromal delirium was associated with a higher incidence of delirium (odds ratio, 8.81; P < 0.01). Conclusion The PRE‐DELIRIC model could be a tool for predicting subsyndromal delirium using a cut‐off value of 36 points.
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Affiliation(s)
- Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Shiro Mishima
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Keiichiro Shimoyama
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Yasuhiro Ueda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Masako Sakurai
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Kentaro Morinaga
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Tsubasa Fujikawa
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku-ku Tokyo Japan
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36
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Evaluating Sleep in a Surgical Trauma Burn Intensive Care Unit: An Elusive Dilemma. Dimens Crit Care Nurs 2018; 37:97-101. [PMID: 29381505 DOI: 10.1097/dcc.0000000000000284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence points to the adverse effects of sleep deprivation on a person's health. Despite decades of attention to the issue, patients, particularly those in the intensive care unit (ICU), continue to suffer. OBJECTIVE The purpose of this pilot study was to examine patients' perceptions of their sleep experience in the surgical trauma burn ICU and identify contributing factors. METHODOLOGY Patients were administered the 6-question Richards-Campbell Sleep Questionnaire (RCSQ) consisting of a 0- to 100-mm scale, with a low score indicating poor sleep quality. They were also asked an additional open-ended question. RESULTS Sixty patients participated. Data revealed a low overall RCSQ score of 43.6 of 100. Of the 5 validated questions on the RCSQ, the question with the lowest mean (35.6) targeted depth of sleep. The question pertaining to falling asleep immediately scored the highest at 52.2. The open-ended question revealed that 37% reported "interruptions" as the reason for not sleeping. Pain was also cited as a factor by 30%, with 11.7% citing discomfort from the bed as an irritant. An additional 21.6% reported noise as the central reason, with "pumps/monitor" noise as the most frequent culprit at 62%. DISCUSSION The pilot study results demonstrate that most participants perceived their sleep as poor in quality. These results direct targeted interventions that can be incorporated to reduce sleep deprivation in ICUs.
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37
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Esquinas AM, Steier JS, Karim HMR. Impact of sleep alterations on weaning duration of mechanically ventilated patients: how much is bad? Eur Respir J 2018; 52:52/1/1800925. [PMID: 29973357 DOI: 10.1183/13993003.00925-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/05/2022]
Affiliation(s)
| | - Joerg S Steier
- Respiratory and Sleep Medicine, Life Sciences and Medicine, King's College London, London, UK.,Lane Fox Unit/Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Habib M R Karim
- Dept of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
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38
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Langerud AK, Rustøen T, Småstuen MC, Kongsgaard U, Stubhaug A. Health-related quality of life in intensive care survivors: Associations with social support, comorbidity, and pain interference. PLoS One 2018; 13:e0199656. [PMID: 29940026 PMCID: PMC6016908 DOI: 10.1371/journal.pone.0199656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/12/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Experiences during a stay in the intensive care unit (ICU), including pain, delirium, physical deterioration, and the critical illness itself, may all influence survivors' health-related quality of life (HRQOL). However, few studies have examined the influence of social support, comorbidity, and pain interference on ICU survivors' HRQOL. OBJECTIVES To investigate possible associations between social support, number of comorbidities, and pain interference on HRQOL in ICU survivors. METHODS ICU survivors responded to a survey 3 months (n = 118) and 1 year (n = 89) after ICU discharge. HRQOL was measured using the Short Form Health Survey-12 (v1), social support using the revised Social Provision Scale, pain interference using the Brief Pain Inventory-Short Form, and comorbidities using the Self-Administered Comorbidity Questionnaire. RESULTS Physical and mental HRQOL were reduced at both 3 months and 1 year in ICU survivors compared with the general population. This reduction was more pronounced at 3 months for physical HRQOL, while a small reduction in mental HRQOL was not clinically relevant. Social support was statistical significantly positively associated with mental HRQOL at 3 months, while number of comorbidities was statistical significantly associated with a reduction in physical HRQOL at 3 months and 1 year and mental HRQOL at 1 year. Lastly pain interference was significantly associated with a reduction in physical HRQOL at 3 months and 1 year. CONCLUSIONS ICU survivors primarily report reduced physical HRQOL. Social support was positively associated with mental HRQOL, while number of comorbidities, and pain interference were all significantly associated with a reduction in HRQOL. Pain interference was associated with the largest reduction in HRQOL.
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Affiliation(s)
- Anne Kathrine Langerud
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Post-operative and Critical Care, Division of Emergencies and Critical Care Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Department of Nursing science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Ulf Kongsgaard
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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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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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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Horsten S, Reinke L, Absalom AR, Tulleken JE. Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill. Br J Anaesth 2017; 120:443-452. [PMID: 29452801 DOI: 10.1016/j.bja.2017.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/30/2017] [Accepted: 12/01/2017] [Indexed: 01/17/2023] Open
Abstract
Intensive-care-unit (ICU) patients exhibit disturbed sleeping patterns, often attributed to environmental noise, although the relative contribution of noise compared to other potentially disrupting factors is often debated. We therefore systematically reviewed studies of the effects of ICU noise on the quality of sleep to determine to what extent noise explains the observed sleep disruption, using the Cochrane Collaboration method for non-randomized studies. Searches in Scopus, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were conducted until May 2017. Twenty papers from 18 studies assessing sleep of adult patients and healthy volunteers in the ICU environment, whilst recording sound levels, were included and independently reviewed by two reviewers. We found that the numbers of arousals between the baseline and the ICU noise condition in healthy subjects differed significantly (mean difference 9.59; 95% confidence interval 2.48-16.70). However, there was considerable heterogeneity between studies (I2 94%, P < 0.00001), and all studies suffered from a considerable risk of bias. The meta-analysis of results was hampered by widely varying definitions of sound parameters between studies and a general lack of detailed description of methods used. It is, therefore, currently impossible to quantify the extent to which noise contributes to sleep disruption among ICU patients, and thus, the potential benefit from noise reduction remains unclear. Regardless, the majority of the observed sleep disturbances remain unexplained. Future studies should, therefore, also focus on more intrinsic sleep-disrupting factors in the ICU environment.
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Affiliation(s)
- S Horsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
| | - L Reinke
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands.
| | - A R Absalom
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
| | - J E Tulleken
- Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands
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Breier JM, Meier ST, Kerr CW, Wright ST, Grant PC, Depner RM. Screening for Delirium: Development and Validation of the Buffalo Delirium Scale for Use in a Home-Based Hospice Setting. Am J Hosp Palliat Care 2017; 35:794-798. [DOI: 10.1177/1049909117739386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jennifer M. Breier
- Research Department, Palliative Care Institute, The Center for Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Scott T. Meier
- Department of Counseling, School and Educational Psychology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Christopher W. Kerr
- Research Department, Palliative Care Institute, The Center for Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Scott T. Wright
- Division of Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Pei C. Grant
- Research Department, Palliative Care Institute, The Center for Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
| | - Rachel M. Depner
- Research Department, Palliative Care Institute, The Center for Hospice and Palliative Care Buffalo, Cheektowaga, NY, USA
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Ding Q, Redeker NS, Pisani MA, Yaggi HK, Knauert MP. Factors Influencing Patients' Sleep in the Intensive Care Unit: Perceptions of Patients and Clinical Staff. Am J Crit Care 2017; 26:278-286. [PMID: 28668912 DOI: 10.4037/ajcc2017333] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Multiple factors are believed to contribute to disruption of patients' sleep and negatively affect clinical outcomes in the intensive care unit. Achieving restorative sleep for critically ill patients remains a challenge. OBJECTIVES To explore the perceptions and beliefs of staff, patients, and surrogates regarding the environmental and nonenvironmental factors in the medical intensive care unit that affect patients' sleep. METHODS This qualitative study included 24 medical intensive care unit staff (7 physicians, 5 respiratory therapists, 10 nurses, and 2 patient-care assistants), 8 patients, and 6 patient surrogates. Semistructured interviews were conducted, and qualitative analysis of content was used to code, categorize, and identify interview themes. RESULTS Interview responses revealed 4 themes with related subthemes: (1) The overnight medical intensive care unit environment does affect sleep, (2) nonenvironmental factors such as difficult emotions and anxiety also affect sleep, (3) respondents' perceptions about sleep quality in the medical intensive care unit were highly variable, and (4) suggestions for sleep improvement included reassuring patients and care-clustering strategies. CONCLUSIONS Results of this study suggest that environment is not the only factor influencing patients' sleep. Decreases in environmental sources of disturbance are necessary but not sufficient for sleep improvement. Guideline-recommended clustered care is needed to provide adequate sleep opportunity, but patients' emotions and anxiety also must be addressed.
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Affiliation(s)
- Qinglan Ding
- Qinglan Ding is a doctoral student at the Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker is a professor at the Yale School of Nursing. Margaret A. Pisani and Henry K. Yaggi are associate professors and Melissa P. Knauert is an assistant professor, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Nancy S. Redeker
- Qinglan Ding is a doctoral student at the Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker is a professor at the Yale School of Nursing. Margaret A. Pisani and Henry K. Yaggi are associate professors and Melissa P. Knauert is an assistant professor, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Margaret A. Pisani
- Qinglan Ding is a doctoral student at the Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker is a professor at the Yale School of Nursing. Margaret A. Pisani and Henry K. Yaggi are associate professors and Melissa P. Knauert is an assistant professor, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Henry K. Yaggi
- Qinglan Ding is a doctoral student at the Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker is a professor at the Yale School of Nursing. Margaret A. Pisani and Henry K. Yaggi are associate professors and Melissa P. Knauert is an assistant professor, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Melissa P. Knauert
- Qinglan Ding is a doctoral student at the Yale School of Nursing, West Haven, Connecticut. Nancy S. Redeker is a professor at the Yale School of Nursing. Margaret A. Pisani and Henry K. Yaggi are associate professors and Melissa P. Knauert is an assistant professor, Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Jeffs EL, Darbyshire JL. Measuring Sleep in the Intensive Care Unit: A Critical Appraisal of the Use of Subjective Methods. J Intensive Care Med 2017. [PMID: 28631532 DOI: 10.1177/0885066617712197] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To collate and appraise the use of subjective measures to assess sleep in the intensive care unit (ICU). DESIGN A systematic search and critical review of the published literature. DATA SOURCES Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature were searched using combinations of the key words "Sleep," "Critical Care," "Intensive Care," and "Sleep Disorders," and this was complemented by hand searching the most recent systematic reviews on related topics. STUDY ELIGIBILITY CRITERIA Papers were limited to non-gray English-language studies of the adult population, published in the last 10 years. OUTCOME MEASURES Primary outcomes were the number and categorization of quantitative studies reporting measures of sleep, the number of participants for each data collection method, and a synthesis of related material to appraise the use of survey tools commonly used for sleep measurement in the ICU. RESULTS Thirty-eight papers reported quantitative empirical data collection on sleep, 17 of which used a primary method of subjective assessment of sleep by the patient or nurse. Thirteen methods of subjective sleep assessment were identified. Many of these tools lacked validity and reliability testing. CONCLUSIONS Research using questionnaires to assess sleep is commonplace in light of practical barriers to polysomnography or other measures of sleep. A methodologically sound approach to tool development and testing is crucial to gather meaningful data, and this robust approach was lacking in many cases. Further research measuring sleep subjectively in ICU should use the Richards Campbell Sleep Questionnaire, and researchers should maintain a commitment to transparency in describing methods.
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Affiliation(s)
- Emma L Jeffs
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Julie L Darbyshire
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Fietze I, Barthe C, Hölzl M, Glos M, Zimmermann S, Bauer-Diefenbach R, Penzel T. The effect of room acoustics on the sleep quality of healthy sleepers. Noise Health 2017; 18:240-246. [PMID: 27762252 PMCID: PMC5187651 DOI: 10.4103/1463-1741.192480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Noise is one of the factors that can seriously disturb sleep, and sound volume is an important factor in this context. One strategy involves avoiding exposure to sounds in the night, while entail the minimization of background noise in a bedroom. The goal of this study was to investigate the effect of systematic sound attenuation on nocturnal sleep by influencing sound volume and reverberation within the context of room acoustics. MATERIALS AND METHODS On this basis, we designed a randomized, controlled crossover trial investigating 24 healthy sleepers (15 men and 9 women, aged 24.9 ± 4.1 years) with a body mass index (BMI) of 21.9 ± 1.6 kg/m2. Each participant slept for three consecutive nights at three different locations: (a) at our sleep lab, (b) at the participant's home, and (c) at an acoustically isolated room. In addition to conduct of polysomnography (PSG), subjective sleep quality and nocturnal noise level were measured at each location. We likewise measured room temperature and relative humidity. RESULTS Under conditions of equal sleep efficiency, a significant increase in deep sleep, by 16-34 min, was determined in an acoustically isolated room in comparison to the two other sleep locations. Fewer arousal events and an increase in rapid eye movement (REM) latency became evident in an acoustically isolated environment. Sleep in a domestic environment was subjectively better than sleep under the two test conditions. DISCUSSION For healthy sleepers, room acoustics influence the microstructure of sleep, without subjective morning benefit. Reduction of noise level and of reverberation leads to an increase in the amount of deep sleep and to reduction of nocturnal arousal events, which is especially important for poor sleepers.
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Affiliation(s)
- Ingo Fietze
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
| | - Charlotte Barthe
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
| | - Matthias Hölzl
- Department of Otorhinolaryngology, Universitätsklinik Magdeburg, Magdeburg; ENT-Center Traunstein, Traunstein, Germany
| | - Martin Glos
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
| | - Sandra Zimmermann
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
| | - Ralf Bauer-Diefenbach
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
| | - Thomas Penzel
- Charité - Universitätsmedizin Berlin, CCM-CC11, Centre for Sleep Medicine, Berlin, Germany
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Luther R, McLeod A. The effect of chronotherapy on delirium in critical care - a systematic review. Nurs Crit Care 2017; 23:283-290. [PMID: 28508438 DOI: 10.1111/nicc.12300] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Delirium is highly prevalent within critical care and is linked to adverse clinical outcomes, increased mortality and impaired quality of life. Development of delirium is thought to be caused by multiple risk factors, including disruption of the circadian rhythm. Chronotherapeutic interventions, such as light therapy, music and use of eye shades, have been suggested as an option to improve circadian rhythm within intensive care units. AIM This review aims to answer the question: Can chronotherapy reduce the prevalence of delirium in adult patients in critical care? DESIGN This study is a systematic review of quantitative studies. RESEARCH METHOD Six major electronic databases were searched, and a hand search was undertaken using selected key search terms. Research quality was assessed using the critical appraisal skills programme tools. The studies were critically appraised by both authors independently, and data were extracted. Four themes addressing the research question were identified and critically evaluated. FINDINGS Six primary research articles that investigated different methods of chronotherapy were identified, and the results suggest that multi-component non-pharmacological interventions are the most effective for reducing the prevalence of delirium in critical care. The melatonergic agonist Ramelteon demonstrated statistically significant reductions in delirium; however, the reliability of the results in answering the review question was limited by the research design. The use of bright light therapy (BLT) and dynamic light application had mixed results, with issues with the research design and outcomes measured limiting the validity of the findings. CONCLUSION Multi-component non-pharmacological interventions, such as noise and light control, can reduce delirium in critical care, whereas other interventions, such as BLT, have mixed outcomes. Melatonin, as a drug, may be a useful alternative to sedative-hypnotics. RELEVANCE TO CLINICAL PRACTICE Chronotherapy can reduce the incidence of delirium within critical care, although further research is warranted. Staff education is essential in the implementation of chronotherapy.
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Affiliation(s)
- Roseanne Luther
- Acute Care Unit, Homerton University Hospital, Homerton NHS Trust, London, UK
| | - Anne McLeod
- Senior Lecturer in Critical Care, School of Health Sciences City, University of London, Northampton Square, London, UK
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47
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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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Lei M, Zhang P, Liu Y, Fu F, Ye L, Zhu T. Propofol and sufentanil may affect the patients' sleep quality independently of the surgical stress response: a prospective nonrandomized controlled trial in 1033 patients' undergone diagnostic upper gastrointestinal endoscopy. BMC Anesthesiol 2017; 17:53. [PMID: 28359259 PMCID: PMC5374607 DOI: 10.1186/s12871-017-0341-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 03/16/2017] [Indexed: 02/05/2023] Open
Abstract
Background It is unknown whether sedative per se contributes to the postoperative sleep disturbance. Diagnostic upper gastrointestinal endoscopy (UGE) is a minimally invasive procedure which is not likely to cause tissue trauma and pain. The purpose of this study was to evaluate the sleep quality of patients undergoing routine (without sedative) diagnostic UGE or UGE with sedative, before, 1 week, and 1 month after the procedure. Methods One thousand and thirty-three patients undergoing UGE were enrolled. Patients chose sedative or without sedative. Propofol and sufentanil were administered to the sedative group, not allowed for the routine group. The Pittsburgh Sleep Quality Index (PSQI) was measured before, 1 week and 1 month after the procedure. Results Five hundred and ten patients were enrolled in the sedative group and 523 in the routine group. One week after the procedure, patients in the sedative group showed significantly higher PSQI scores (worse sleep quality) than the baseline PSQI scores (p < 0.001), but there was no significant change for the routine group in the same period (p = 0.096). One month after the procedure, there was no significant difference in PSQI scores between the two groups compared with the baseline values (p = 0.358 for sedative group, p = 0.161 for routine group). There were also no significant difference in the PSQI scores between the two groups in the entire 1 month follow-up period (p = 0.885). Conclusions The sedative group showed impaired sleep quality 1 week after diagnostic UGE. Propofol and sufentanil may independently affect the sleep quality of patients after sedative of diagnostic UGE for only one week. Trial registration This study is registered on Chinese Clinical Trial Registry (IDChiCTR-OCH-13003128). Registered 2 April 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12871-017-0341-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Lei
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Current address: Department of Anaesthesiology, AVIC 363 Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Peng Zhang
- Department of Anaesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Yunfei Liu
- Department of Anaesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Fangfang Fu
- Department of Anaesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Ling Ye
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China.
| | - Tao Zhu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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Nursing Interactions With Intensive Care Unit Patients Affected by Sleep Deprivation: An Observational Study. Dimens Crit Care Nurs 2017; 35:154-9. [PMID: 27043401 DOI: 10.1097/dcc.0000000000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients in intensive care units (ICUs) often experience sleep deprivation due to different factors. Its consequences are damaging both physiologically and psychologically. This study focuses particularly on nursing interactions as the main factor involved in sleep deprivation issues. OBJECTIVES The aims of this study were to examine the frequency, pattern, and types of nocturnal care interactions with patients in the respiratory and cardiology ICUs; analyze the relationship between these interactions and patients' variables (age, sex, recovery diagnosis, and acuity of care); and analyze the differences in patterns of nocturnal care interactions among the units. METHODS This is an observational retrospective study that analyzes the frequency, pattern, and types of nocturnal care interactions with patients between 7 PM and 6 AM recording data in the activity data sheets. RESULTS Data consisted of 93 data assessment sheets. The mean number of care interactions per night was 18.65 (SD, 3.71). In both ICUs, interactions were most frequent at 7 PM, 10 PM, and 6 AM. Only 8 uninterrupted sleep periods occurred. Frequency of interactions correlated significantly with patients' acuity scores and the number of nurse interventions in both ICUs. CONCLUSIONS Patients in ICUs have fragmented sleep patterns. This study underlines the need to develop new management approaches to promote and maintain sleep.
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McKenna HT, Reiss IK, Martin DS. The significance of circadian rhythms and dysrhythmias in critical illness. J Intensive Care Soc 2017; 18:121-129. [PMID: 28979558 DOI: 10.1177/1751143717692603] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Many physiological and cellular processes cycle with time, with the period between one peak and the next being roughly equal to 24 h. These circadian rhythms underlie 'permissive homeostasis', whereby anticipation of periods of increased energy demand or stress may enhance the function of individual cells, organ systems or whole organisms. Many physiological variables related to survival during critical illness have a circadian rhythm, including the sleep/wake cycle, haemodynamic and respiratory indices, immunity and coagulation, but their clinical significance remains underappreciated. Critically ill patients suffer from circadian dysrhythmia, manifesting overtly as sleep disturbance and delirium, but with widespread covert effects on cellular and organ function. Environmental and pharmacological strategies that ameliorate or prevent circadian dysrhythmia have demonstrated clinical benefit. Harnessing these important biological phenomena to match metabolic supply to demand and bolster cell defenses at the apposite time may be a future therapeutic strategy in the intensive care unit.
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Affiliation(s)
- Helen T McKenna
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Critical Care Unit, The London Clinic, London, UK.,Intensive Care Unit, Royal Free Hospital, London, UK
| | - Irwin Km Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Daniel S Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Intensive Care Unit, Royal Free Hospital, London, UK.,University College London Division of Surgery and Interventional Science, Royal Free Hospital, London, UK
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