Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Critical Care Medicine, Год журнала: 2018, Номер 46(9), С. e825 - e873

Опубликована: Авг. 16, 2018

To update and expand the 2013 Clinical Practice Guidelines for Management of Pain, Agitation, Delirium in Adult Patients ICU.Thirty-two international experts, four methodologists, critical illness survivors met virtually at least monthly. All section groups gathered face-to-face annual Society Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict interest policy was developed a priori enforced throughout process. Teleconferences electronic discussions among subgroups whole panel were part guidelines' development. general content review completed by all members January 2017.Content ICU represented each five sections guidelines: Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), Sleep (disruption). Each created Population, Intervention, Comparison, Outcome, nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, patients prioritized importance. For Outcome question, searched best available evidence, determined its quality, formulated recommendations as "strong," "conditional," or "good" practice statements Grading Recommendations Assessment, Development Evaluation principles. In addition, evidence gaps caveats explicitly identified.The Agitation/Sedation, (disruption) issued 37 (three strong 34 conditional), two good statements, 32 ungraded, nonactionable statements. Three from patient-centered question list remained without recommendation.We found substantial agreement large, interdisciplinary cohort experts regarding supporting recommendations, remaining literature assessment, prevention, treatment critically ill adults. Highlighting this research needs will improve management provide foundation improved outcomes science vulnerable population.

Язык: Английский

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Sleep in the Intensive Care Unit

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2015, Номер 191(7), С. 731 - 738

Опубликована: Янв. 16, 2015

Section:ChooseTop of pageAbstract <

Язык: Английский

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Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit

Anesthesiology, Год журнала: 2016, Номер 125(5), С. 979 - 991

Опубликована: Авг. 27, 2016

Patients admitted to the intensive care unit (ICU) after surgery often develop sleep disturbances. The authors tested hypothesis that low-dose dexmedetomidine infusion could improve architecture in nonmechanically ventilated elderly patients ICU surgery.This was a pilot, randomized controlled trial. Seventy-six age 65 yr or older who were noncardiac and did not require mechanical ventilation receive (continuous at rate of 0.1 μg kg h; n = 38) placebo (n for 15 h, i.e., from 5:00 PM on day until 8:00 AM first surgery. Polysomnogram monitored during period study-drug infusion. primary endpoint percentage stage 2 non-rapid eye movement (stage N2) sleep.Complete polysomnogram recordings obtained 61 (30 group 31 group). Dexmedetomidine increased N2 median 15.8% (interquartile range, 1.3 62.8) with 43.5% (16.6 80.2) (difference, 14.7%; 95% CI, 0.0 31.9; P 0.048); it also prolonged total time, decreased N1 sleep, efficiency, improved subjective quality. incidence hypotension without significant intervention.In surgery, prophylactic may overall

Язык: Английский

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Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units

Critical Care, Год журнала: 2018, Номер 22(1)

Опубликована: Окт. 5, 2018

High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about effect of on sleep quality ICU patients. The study aim to determine subjective quality. This was multicenter observational six Dutch ICUs. Noise recording equipment installed 2–4 rooms per ICU. Adult patients were eligible for 48 h after admission and followed up maximum five nights Exclusion criteria presence delirium and/or inability be assessed Sleep evaluated using Richards Campbell Questionnaire (range 0–100 mm). recordings used analysis various auditory parameters, including number duration restorative periods. Hierarchical mixed model regression associations between sleep. In total, 64 (68% male), mean age 63.9 (± 11.7) years Acute Physiology And Chronic Health Evaluation (APACHE) II score 21.1 7.1) included. Average 56 ± 24 mm. 24-h average sound pressure (LAeq, 24h) 54.0 dBA 2.4). Mixed-effects analyses showed that background (β = − 0.51, p < 0.05) had negative impact quality, whereas periods 0.53, 0.01) female sex 1.25, weakly but significantly correlated with negatively associated gender positively www.ClinicalTrials.gov, NCT01826799 . Registered 9 April 2013.

Язык: Английский

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Actigraphy to Evaluate Sleep in the Intensive Care Unit. A Systematic Review

Annals of the American Thoracic Society, Год журнала: 2018, Номер 15(9), С. 1075 - 1082

Опубликована: Июнь 26, 2018

Poor sleep quality is common in the intensive care unit (ICU) and may be associated with adverse outcomes. Hence, ICU-based efforts to promote are gaining attention, motivating interest methods measure critically ill patients. Actigraphy evaluates rest activity by algorithmically processing gross motor data, usually collected a noninvasive wristwatch-like accelerometer device. In patients, actigraphy has been used as surrogate of sleep; however, its use not systematically reviewed.

Язык: Английский

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Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2023, Номер 207(7), С. e49 - e68

Опубликована: Март 31, 2023

Section:ChooseTop of pageAbstract <

Язык: Английский

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Delirium Transitions in the Medical ICU

Critical Care Medicine, Год журнала: 2014, Номер 43(1), С. 135 - 141

Опубликована: Сен. 17, 2014

Disrupted sleep is a common and potentially modifiable risk factor for delirium in the ICU. As part of quality improvement project to promote ICU, we examined association perceived ratings other patient ICU factors with daily transition delirium.Secondary analysis prospective observational study.Medical over 201-day period.Two hundred twenty-three patients greater than or equal one night medical between two consecutive days assessment.None.Daily were measured using Richards-Campbell Sleep Questionnaire. Delirium was twice Confusion Assessment Method Other covariates evaluated included age, sex, race, admission diagnosis, nighttime mechanical ventilation status, prior day's sedation benzodiazepines opioids, via both bolus continuous infusion. Perceived similar who ever versus never delirious (median [interquartile range] ratings, 58 [35-76] vs 57 [33-78], respectively; p = 0.71), unrelated (adjusted odds ratio, 1.00; 95% CI, 0.99-1.00). In mechanically ventilated patients, receipt benzodiazepine and/or opioid infusion associated 4.02; 2.19-7.38; < 0.001), reporting use pharmacological aids at home less likely 0.40; 0.20-0.80; 0.01).We found no delirium. Infusion medications strongly an important, critically ill patients.

Язык: Английский

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Sleep assessment of hospitalised patients: A literature review

International Journal of Nursing Studies, Год журнала: 2014, Номер 51(9), С. 1281 - 1288

Опубликована: Фев. 15, 2014

Язык: Английский

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Sleep in the intensive care unit

Jornal Brasileiro de Pneumologia, Год журнала: 2015, Номер 41(6), С. 539 - 546

Опубликована: Дек. 1, 2015

ABSTRACT Poor sleep quality is a consistently reported by patients in the ICU. In such potentially hostile environment, extremely fragmented and architecture unconventional, with predominance of superficial stages limited amount time spent restorative stages. Among causes disruption ICU are factors intrinsic to acute nature their condition, as well related environment treatments administered, mechanical ventilation drug therapy. Although consequences poor for recovery remain unknown, it seems influence immune, metabolic, cardiovascular, respiratory, neurological systems. There evidence that multifaceted interventions focused on minimizing nocturnal disruptions improve patients. this article, we review literature regarding normal We also analyze assessment methods; its potential implications process critically ill patients; strategies promotion.

Язык: Английский

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The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework*

Critical Care Medicine, Год журнала: 2016, Номер 44(12), С. 2231 - 2240

Опубликована: Авг. 9, 2016

This study aimed to assess whether interventions targeted at improving sleep in the ICU were associated with reductions delirium. Secondary outcomes include duration of delirium and length stay.MEDLINE, CINAHL, Web Science, Scopus, WorldCat, International Pharmaceutical Abstracts searched from inception January 2016.Studies investigating any type intervention (nonpharmacologic or pharmacologic) assessing impact on included. Any design was permitted so long as assessment made least daily a validated tool.The following data extracted: first author, year publication, design, type, components intervention, use tool, patient age, sex, severity illness, measures, incidence delirium, stay. The used compare rates across studies. Methodologic quality included studies evaluated using Effective Public Health Practice Project tool.Of 488 citations screened, 10 identified for inclusion final review; six which demonstrated statistically significant reduction intervention. Four assessed delirium; which, three reported shorter Two reduced In regard risk bias, only one strong. Multiple confounders qualitative heterogeneity limit both conclusions that can be drawn these findings quantitative pooling data.Although seem promising approach delirium-related outcomes, are limited by bias issues, varying methodologies, multiple confounders, making evidence base this conclusion best. Future would benefit systematic studying link between is outlined context reviewing existing literature.

Язык: Английский

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