Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis

ObjectiveSleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the nonpharmacological interventions provided to improve sleep or prevent delirium in ICU patients or both and integrate their effect sizes.Review methodsThis study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).ResultsThe systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = −0.68, 95% CI = −0.93 to −0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention.ConclusionsOur results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person–environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium.Prospero reference numberCRD42021230815     

Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis

BackgroundSleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely.ObjectiveTo estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation.MethodsElectronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included.ResultsWe found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards–Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation.ConclusionSleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.     

Effects of an interactive handgrip game on surgical patients requiring intensive care: An assessor-blinded randomized controlled trial

ObjectiveTo explore the effect of an interactive handgrip game on psychological distress and handgrip strength among critically ill surgical patients.DesignA randomised controlled trial.SettingA surgical intensive care unit.InterventionParticipants were enrolled in the program within 48 hours of admission to the intensive care unit. Patients in the intervention group played a 20-minute interactive handgrip game twice daily for a maximum of three days in the intensive care unit in addition to routinely passive physical rehabilitation. Patients in the routine care group had a daily target of 20 min of passive physical rehabilitation as needed.MeasurementThe primary outcomes included depression, anxiety, and stress measured using the shortened version of the Depression Anxiety Stress Score scale. The secondary outcomes were perceived sleep evaluated using the Richards–Campbell Sleep Questionnaire, delirium assessed using the Intensive Care Delirium Screening Checklist, and handgrip strength measured using handgrip dynamometry within a handgrip device.ResultsTwo hundred and twenty-seven patients were eligible and 70 patients were recruited in the intervention (n = 35) and routine care groups (n = 35). The patients in the intervention group had lower scores (median = 6.0, 4.0, and 12.0) for depression, anxiety, and stress compared with those in the routine care group (12.0, 12.0, and 20.0; all p < 0.05). The interactive handgrip game did not significantly improve sleep quality and prevent the occurrence of delirium (both p > 0.05). The patients who received the interactive handgrip game intervention exhibited significantly enhanced handgrip strength in both hands over time (both p < 0.001).ConclusionAn interactive handgrip game may benefit the psychological well-being and handgrip strength of critically ill patients.Implications for Clinical PracticeInteractive handgrip games is effective active exercise which should be integrated into routine nursing practice.     

Outcomes of daytime nurse practitioner–staffed versus resident-staffed nonsurgical intensive care units: A retrospective observational study

BackgroundRapid developments in medical care—such as monitoring devices, medications, and working hours restrictions for intensive care personnel—have dramatically increased the demand for intensive care physicians. Therefore, nurse practitioner (NP)–staffed care is becoming increasingly important. This study was aimed to compare the outcomes of daytime NP-staffed and daytime resident-staffed nonsurgical intensive care units (ICU).MethodsWe retrospectively assessed patients admitted to a nonsurgical ICU from March 2017 to December 2017. We collected basic patient data, including age, sex, admission diagnosis, transferring unit, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Primary endpoints were ICU mortality, hospital mortality, and 30-day mortality. Secondary endpoints were 48-h readmission, discharge to nonhome locations, and lengths of ICU and hospital stay.ResultsA total of 838 subjects were analysed: 334 subjects in the NP-staffed group and 504 in the resident-staffed group. The NP-staffed group was more likely to come from inpatient units (38.3% vs 16.5% for resident-staffed group; p < 0.001) and had lower disease severity (APACHE II score, 13.9 ± 8.4 vs 15.1 ± 8.2 for resident-staffed group; p = 0.047). After adjusting for age, sex, location before ICU admission, APACHE II score, and significantly different basic characteristics, there were no differences in ICU mortality, hospital mortality, or 30-day mortality between the two groups. Secondary analysis showed the NP-staffed group had a lower discharge rate to nonhome locations (2.1% vs 6.3%; p = 0.023) and shorter hospital stay (12.1 ± 14.1 vs 14.2 ± 14.3 days; p = 0.015).ConclusionsWe observed no difference in mortality between daytime NP-staffed and resident-staffed nonsurgical ICUs. Daytime NP-staffed care is an effective, safe, feasible method for staffing nonsurgical ICUs.     

Central venous pressure,global end-diastolic index,and the inferior vena cava collapsibility/distensibility indices to estimate intravascular volume status in critically ill children: A pilot study

BackgroundThe assessment of the volume status in critically ill paediatric patients in intensive care units is vitally important for fluid therapy management. The most commonly used parameter for detecting volume status is still central venous pressure (CVP); however, in recent years, various kinds of methods and devices are being used for volume assessment in intensive care units.ObjectivesWe aimed to evaluate the relationship between CVP, the global end-diastolic index (GEDI), and ultrasound measurements of the collapsibility and distensibility indices of the inferior vena cava (IVC) in paediatric patients undergoing Pulse index Contour Cardiac Output (PiCCO) monitoring.MethodsFifteen patients receiving PiCCO monitoring were prospectively included in the study. Forty-nine PiCCO measurements were evaluated, and simultaneous CVP values were noted. After each measurement, IVC collapsibility (in spontaneously breathing patients) and distensibility (in mechanically ventilated patients) indices were measured with bedside ultrasound.ResultsThe mean age was 93.2 ± 61.3 months. Significant and negative correlations of the GEDI were found with the IVC collapsibility index (in spontaneously breathing patients) and the IVC distensibility index (in mechanically ventilated patients) (r = ?0.502, p < 0.001; r = ?0.522, p = 0.001, respectively). A significant and weakly positive correlation was found between the GEDI and CVP (r = 0.346, p = 0.015), and a significant and negative correlation was found between the IVC collapsibility index and CVP (r = ?0.482, p = 0.03). The correlation between the IVC distensibility index and CVP was significant and negative (r = ?0.412, p = 0.04).ConclusionThe use of PiCCO as an advanced haemodynamic monitoring method and the use of bedside ultrasound as a noninvasive method are useful to evaluate the volume status in critically ill paediatric patients in intensive care. These methods will gradually come to the fore in paediatric intensive care.     

Comparing rehabilitation outcomes for patients admitted to the intensive care unit with COVID-19 requiring mechanical ventilation during the first two waves of the pandemic: A service evaluation

ObjectivesTo compare rehabilitation outcomes of patients admitted to the intensive care unit with COVID-19 and mechanically ventilated during wave 1 and 2, receiving two different models of physiotherapy delivery.MethodsAdults admitted to the intensive care unit between October–March 2021 (wave 2) with a confirmed diagnosis of COVID-19 and mechanically ventilated for >24 hours were included. During wave 2, rehabilitation was provided by physiotherapists over five days, with only emergency respiratory physiotherapy delivered at weekends. Rehabilitation status was measured daily using the Manchester Mobility Score to identify time taken to first mobilise and highest level of mobility achieved at ICU discharge. Outcomes were compared to data previously published from the same ICU during ‘wave 1’ (March–April 2020) when a seven-day rehabilitation physiotherapy service was provided.ResultsA total of n = 291 patients were included in analysis; 110 from wave 1, and 181 from wave 2. Patient characteristics and medical management were similar between waves. Mean ± SD time to first mobilise was slower in wave 2 (15 ± 11 days vs 14 ± 7 days), with overall mobility scores lower at both ICU (MMS 5 (Step transferring) vs MMS 4 (standing practice) (4), p < 0.05) and hospital (MMS 7 (Mobile > 30 m MMS) vs MMS 6 (Mobile < 30 m MMS), p < 0.0001) discharge. Significantly more patients in wave 2 required ongoing rehabilitation either at home or as an inpatient compared to wave 1 (81 % vs 49 %, p = 0.003).ConclusionThe change in physiotherapy staff provision from a seven-day rehabilitation service during wave 1 to a five day rehabilitation service with emergency respiratory physio only at weekends in wave 2 was associated with delayed time to first mobilise, lower levels of mobility at both intensive care unit and hospital discharge and higher requirement for ongoing rehabilitation at the point of hospital discharge.     

The effects of a sensory stimulation intervention on psychosocial and clinical outcomes of critically ill patients and their families: A randomised controlled trial

ObjectivesTo explore the effectiveness of a sensory stimulation intervention on intensive care unit patients' psychosocial, clinical, and family outcomes.DesignA prospective, assessor-blind, parallel-group randomised controlled trial.SettingA surgical intensive care unit of one tertiary hospital in Guangzhou, mainland China.InterventionParticipants in the intervention group received a daily 30-minute auditory and visual stimulation session starting from recruitment and for a maximum of seven days while in the intensive care unit.Measurement and main resultsOne hundred fifty-two patients and family caregiver dyads were recruited. Patients in the intervention group showed lower total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 27.62 ± 10.35, p = 0.001), depressive symptoms (3.76 ± 3.99 vs 6.78 ± 4.75, p = 0.001) and delusional memories (0.47 ± 0.92 vs 0.82 ± 1.23, p = 0.001) collected immediately post-intervention than those in the control group, while not on depressive symptoms at one-month post-intervention (3.32 ± 4.03 vs 3.28 ± 3.77, p = 0.800). Sensory stimulation did not significantly impact patients' unit length of stay and 30-day mortality (all p > 0.05). For family outcomes, family caregivers in the intervention group had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97, p = 0.001) and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68, p = 0.001) than family caregivers in the control group.ConclusionsSensory stimulation may benefit patients' and family caregivers' psychological well-being, and further well-designed multi-centre clustered randomized controlled trials could be considered to strengthen the evidence.     

Treatment of infant colic with craniosacral therapy. A randomized controlled trial

ObjectiveTo evaluate the number of craniosacral therapy sessions that can be helpful to obtain a resolution of the symptoms of infantile colic and to observe if there are any differences in the evolution obtained by the groups that received a different number of Craniosacral Therapy sessions at 24 days of treatment, compared with the control group which did not received any treatment.MethodsFifty-eight infants with colic were randomized into two groups of which 29 babies in the control group received no treatment and those in the experimental group received 1–3 sessions of craniosacral therapy (CST) until symptoms were resolved. Evaluations were performed until day 24 of the study. In this study crying hours served as primary outcome. The secondary outcome were the hours of sleep and the severity, measured by an Infantile Colic Severity Questionnaire (ICSQ).ResultsSignificant statistical differences were observed in favor of experimental group compared to the control group on day 24 in crying hours (mean difference = 2.94, at 95 %CI = 2.30–3.58; p < 0.001) primary outcome, and also in hours of sleep (mean difference = 2.80; at 95 %CI = − 3.85 to − 1.73; p < 0.001) and colic severity (mean difference = 17.24; at 95 %CI = 14.42–20.05; p < 0.001) secondary outcomes.Also, the differences between the groups ≤ 2 CST sessions (n = 19), 3 CST sessions (n = 10) and control (n = 25) were statistically significant on day 24 of the treatment for crying, sleep and colic severity outcomes (p < 0.001).ConclusionBabies with infantile colic may obtain a complete resolution of symptoms on day 24 by receiving 2 or 3 CST sessions compared to the control group, which did not receive any treatment.     

Prevalence and management of delirium in intensive care units in the Netherlands: An observational multicentre study

ObjectivesThis study aimed to determine the prevalence, risk factors of delirium and current practice of delirium management in intensive care units of various levels of care.Research methodology/designProspective multicentre cohort study.SettingIn all adult patients admitted to one of the participating intensive care units on World Delirium Awareness Day 2018, delirium point and period prevalence rates were measured between ICU admission and seven days after the index day.ResultsIn total, 28 (33%) Dutch intensive care units participated in this study. Point-prevalence was 23% (range 41), and period-prevalence was 42% (range 70). University intensive care units had a significantly higher delirium point-prevalence compared with non-university units (26% vs.15%, p = 0.02). No significant difference were found in period prevalence (50% vs. 39%, p = 0.09). Precipitating risk factors, infection and mechanical ventilation differed significantly between delirium and non-delirium patients. No differences were observed for predisposing risk factors. A delirium protocol was present in 89% of the ICUs. Mean delirium assessment compliance measured was 84% (±19) in 14 units and estimated 59% (±29) in the other 14.ConclusionDelirium prevalence in Dutch intensive care units is substantial and occurs with a large variation, with the highest prevalence in university units. Precipitating risk factors were more frequent in patients with delirium. In the majority of units a delirium management protocol is in place.     

Effects of neuromuscular electrical stimulation in critically ill patients: A systematic review and meta-analysis of randomised controlled trials

ObjectivesWe performed a systematic review and meta-analysis to examine the effect of neuromuscular electrical stimulation (NES) on prevention of critical care myopathy and its effect on various clinical outcomes in the intensive care unit (ICU).Review methods usedThis study involved systematic review and meta-analysis of randomised controlled trials (RCTs) comparing NES (applied to different muscle groups combined with usual care) and usual care (passive and active exercises along with early mobilisation and rehabilitation). Included studies enrolled adult patients managed in the ICU for medical or surgical diseases who were or were not mechanically ventilated. The primary outcome was global muscle strength measured by the Medical Research Council grading system. Secondary outcomes included ICU mortality, duration of mechanical ventilation (MV), and ICU length of stay. Risk ratio for dichotomous data and mean difference (MD) for continuous data with their corresponding 95% confidence interval (CI) were calculated.Data sourceA search in major electronic databases, including PubMed, Cochrane Library, and Embase, from inception to November 2018 was carried out.ResultsSix RCTs were included, representing 718 patients. The mean age 60 ± 15.3 years, and 60.6% were male. There was no significant difference between NES and usual care on global muscle strength measured by Medical Research Council grading system (MD: 0.45; 95% CI: −2.89 to 3.80; p = 0.79), ICU mortality (risk ratio: 1.30; 95% CI: 0.95–1.78; p = 0.10), duration of MV (days) (MD: -2.07; 95% CI: −5.06 to 0.92; p = 0.18), or ICU length of stay (days) (MD: -3.06; 95% CI: -9.79 to 3.68; p = 0.37) in comparison with the usual therapy alone in critically ill patients.ConclusionNES combined with usual care was not associated with significant differences in global muscle strength, ICU mortality, duration of MV, or ICU length of stay in comparison with usual care alone in critically ill patients. Further RCTs are needed to determine patients with maximum benefit and to examine NES safety and efficacy.     

Pharmacoepidemiology of metaraminol in critically ill patients with shock in a tertiary care hospital

BackgroundMetaraminol is increasingly used as a vasopressor in critically ill patients. Nevertheless, there remains limited evidence to support its use in international guidelines for management of shock.ObjectivesThe aim of the study was to describe the pharmacoepidemiology of metaraminol in critically ill patients with shock.MethodsA retrospective observational study was conducted in an intensive care unit (ICU) in Sydney, Australia. Patients admitted during a 1-year time frame who received metaraminol intravenous infusions for management of shock were included.ResultsA total of 152 patients were included. When metaraminol was used, it was the most common first-line vasopressor started for management of shock (97%, n = 147) and was used as monotherapy in 53% (n = 81) of patients. The median duration of metaraminol infusion in the ICU was 7 h (interquartile range [IQR] = 3 to 19), and the median maximum metaraminol infusion rate in the ICU was 4.0 mg/h (IQR = 2.5 to 6.0). Peripheral vasopressor infusions were used in 96% (n = 146/152) of patients for a median duration of 7 h (IQR = 2 to 18). In all these cases, the peripheral vasopressor used was metaraminol (100%, n = 146/146). Patients were commonly switched from metaraminol to noradrenaline infusions after insertion of a central venous catheter (R2 = 0.89). Patients treated with metaraminol monotherapy had a lower Acute Physiology and Chronic Health Evaluation III score (58 vs 68; median difference = −9, 95% confidence interval = −16 to −3; p < 0.01) and a shorter duration of overall vasopressor use in the ICU (12 vs 39 h, median difference = −24 h, 95% confidence interval = −31 to −18; p < 0.01) than those treated with combination vasopressors. No extravasation injury was reported in the study cohort.ConclusionsMetaraminol is often administered as a first-line peripheral vasopressor in the ICU and is used as a single agent in patients with lower severity of shock.     

Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus

PurposeTo investigate the sleep quality of patients with type 2 diabetes (T2D) and its impact on glycaemic control.MethodsUsing a convenience sampling method, 220 patients with T2D were recruited. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality with threshold at PSQI ≥ 8. The glycosylated haemoglobin A1c (HbA1c) test was used to measure the glycaemic control with threshold at HbA1c < 7%.ResultsThe PSQI score was 8.30 ± 4.12. The sleep disorder incidence rate was 47.1%. Patients with HbA1c ≥ 7% had significantly lower PSQI global and factor scores (p < 0.01) versus the control group. Sleep latency, sleep disturbance, and daytime dysfunction were the risk factors for poor glycaemic control.ConclusionPatients with T2D have high sleep disorder rate negatively impacting glycaemic control. Health care providers should pay close attention to the sleep quality of T2D patients, and provide them with appropriate educational material.     

Gut function in the intensive care unit – What is ‘normal’?

BackgroundManagement of gut function in the intensive care unit (ICU) is often protocol-driven. Protocols for enteral feeding or bowel management are based on assumptions about what is ‘normal’ gastrointestinal motility during critical illness or in the early postoperative period, although ‘normal’ has not been well described in this group.ObjectivesThis study aimed to describe aspects of gut function based on an audit of current ICU patients.MethodsA retrospective medical audit of 100 recent consecutive ICU patients was conducted to obtain data on gut function parameters in the critically ill or postoperative population.ResultsThe audit indicated that delayed gastric emptying is common in the ICU. Regardless of the definition volume used, large gastric aspirates occurred in most enterally fed patients. Patient positioning was a significant influence, with a bed angle <30° associated with increased gastric aspirates (p = 0.0002). Constipation was more common among enterally fed patients than among orally fed ones (p = 0.001) and was associated with opioids (p = 0.009). Diarrhoea was associated with antibiotic use (p = 0.047). For enterally fed patients, the first bowel motion in the ICU occurred on average day 4.60 (standard deviation, 2.78), compared to day 2.72 (standard deviation, 1.67) for orally fed patients (p = 0.0001).ConclusionAlteration of upper and lower gastrointestinal motility is common in critically ill and early postoperative patients. Care should be taken in interpreting protocols that relate to gut function to avoid unnecessary interventions or interruptions to nutritional therapy.     

The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis

BackgroundDespite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited.ObjectivesThis study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors.MethodsWe analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life.ResultsThe participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = ?0.48, p < 0.001), unemployment (β = ?0.19, p < 0.001), low income (β = ?0.11, p = 0.004), older age (β = ?0.08, p = 0.039), and cognitive impairment (β = ?0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = ?0.49, p < 0.001) and cognitive impairment (β = ?0.14, p = 0.005) and low income (β = ?0.09, p = 0.014) predicted mental component summary scores.ConclusionsThe participants reported poor physical and mental health–related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.     

The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey

BackgroundPerson-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined.ObjectivesThe aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients.MethodsThis study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression.ResultsPerson-centred care was associated with ‘awareness of surroundings’ (β = 0.29, p < .001), ‘frightening experiences’ (β = ?0.31, p < .001), and ‘satisfaction with care’ (β = 0.54, p < .001). However, there was no significant association between person-centred care and ‘recall of experience’.ConclusionsWe observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.     

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep‐promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep‐promoting interventions has not been widely reported. An observational study was conducted in a 58‐bed adult intensive care unit. Sleep quality was assessed using the Richards‐Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep‐promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open‐ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep‐promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards‐Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards‐Campbell Sleep Questionnaire was used on repeated occasions, and sleep‐promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards‐Campbell Sleep Questionnaire for the subjective self‐assessment of sleep quality in intensive care unit patients and the implementation of simple‐promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.     

Factors affecting sleep in the critically ill: An observational study

Purpose

The aims of the current study were to describe the extrinsic and intrinsic factors affecting sleep in critically ill patients and to examine potential relationships with sleep quality.

Materials and Methods

Sleep was recorded using polysomnography (PSG) and self-reports collected in adult patients in intensive care. Sound and illuminance levels were recorded during sleep recording. Objective sleep quality was quantified using total sleep time divided by the number of sleep periods (PSG sleep period time ratio). A regression model was specified using the “PSG sleep period time ratio” as a dependent variable.

Results

Sleep was highly fragmented. Patients rated noise and light as the most sleep disruptive. Continuous equivalent sound levels were 56 dB (A). Median daytime illuminance level was 74 lux, and nighttime levels were 1 lux. The regression model explained 25% of the variance in sleep quality (P = .027); the presence of an artificial airway was the only statistically significant predictor in the model (P = .007).

Conclusions

The presence of an artificial airway during sleep monitoring was the only significant predictor in the regression model and may suggest that although potentially uncomfortable, an artificial airway may actually promote sleep. This requires further investigation.     

Effects of a pedometer-based walking intervention on young adults’ sleep quality,stress and life satisfaction: Randomized controlled trial

ObjectiveThe purpose of this study was to evaluate the effect of daily walking exercise on sleep quality, perceived stress and life satisfaction. It aimed to investigate the interaction between daily walking exercise and sleep components (sleep quality, sleep latency, sleep duration, sleep disturbance, sleep medication use, and daytime functioning).MethodsA four-week randomized control trial (RCT) was conducted by assigning 54 research volunteers into two groups randomly. The participants in the intervention group (IG) were asked to carry out a daily aerobic walking exercise (DAWE), and participants in the control group (CG) were requested to maintain a sedentary life style. Sleep quality, perceived stress and life satisfaction were assessed at the baseline and at the end of the intervention. All participants were equipped with Omron HJ-112 pedometer to record their daily exercise and to fulfil a daily diary sheet.ResultsBy the end of the intervention, 26 out of 54 participants (M_age = 24.96; SD = 5.13) completed the task. There was no statistical significance between the two groups when comparing global sleep quality, stress and life satisfaction. The within group comparison showed positive effect of DAWE on subjective sleep quality (p = 0.05), less sleep medication use (p < 0.05), positive effect on daytime function (p < 0.01) and improved life satisfaction (p = 0.05) after four weeks of intervention.ConclusionFindings suggested that incorporating daily aerobic walking exercise might be beneficial to sleep health. Further studies are suggested to ascertain the pedometer-based daily walking exercise's long-term effects and to unfold the biological mechanisms leading to its sleep quality improvement effect.     

Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis

IntroductionDelirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.MethodsThis interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.ResultsA significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (−3.7% per time period, p = 0.02). Quality of sleep was unaffected (0.3 per time period, p = 0.85). The post-intervention group used significantly less sleep-inducing medication (p < 0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50–80 versus 70, IQR: 60–80, p = 0.02).ConclusionsThe incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.