Effects of Dexmedetomidine on Sleep Quality in Critically Ill Patients

Abstract Background: Dexmedetomidine, a potent α-2-adrenergic agonist, is widely used as sedative in critically ill patients. This pilot study was designed to assess the effect of dexmedetomidine administration on sleep quality in critically ill patients. Methods: Polysomnography was performed on hemodynamically stable critically ill patients for 57 consecutive hours, divided into three night-time (9:00 pm to 6:00 am) and two daytime (6:00 am to 9:00 pm) periods. On the second night, dexmedetomidine was given by a continuous infusion targeting a sedation level −1 to −2 on the Richmond Agitation Sedation Scale. Other sedatives were not permitted. Results: Thirteen patients were studied. Dexmedetomidine was given in a dose of 0.6 μg kg−1 h−1 (0.4 to 0.7) (median [interquartile range]). Compared to first and third nights (without dexmedetomidine), sleep efficiency was significantly higher during the second night (first: 9.7% [1.6 to 45.1], second: 64.8% [51.4 to 79.9], third: 6.9% [0.0 to 17.1], P < 0.002). Without dexmedetomidine, night-time sleep fragmentation index (7.6 events per hour [4.8 to 14.2]) and stage 1 of sleep (48.0% [30.1 to 66.4]) were significantly higher (P = 0.023 and P = 0.006, respectively), and stage 2 (47.0% [27.5 to 61.2]) showed values lower (P = 0.006) than the corresponding values (2.7 events per hour [1.6 to 4.9], 13.1% [6.2 to 23.6], 80.2% [68.9 to 92.8]) observed with dexmedetomidine. Without sedation, sleep was equally distributed between day and night, a pattern that was modified significantly (P = 0.032) by night-time dexmedetomidine infusion, with more than three quarters of sleep occurring during the night (79% [66 to 87]). Conclusion: In highly selected critically ill patients, dexmedetomidine infusion during the night to achieve light sedation improves sleep by increasing sleep efficiency and stage 2 and modifies the 24-h sleep pattern by shifting sleep mainly to the night.

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Evaluation of Dexmedetomidine Dosing in Obese Critically Ill Patients

Journal of Pharmacy Practice ◽

10.1177/08971900211021578 ◽

2021 ◽

pp. 089719002110215

Author(s):

Sara A. Atyia ◽

Keaton S. Smetana ◽

Minh C. Tong ◽

Molly J. Thompson ◽

Kari M. Cape ◽

...

Keyword(s):

Body Weight ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Difference ◽

Ideal Body Weight ◽

Weight Percentage ◽

Before And After ◽

Light Sedation ◽

Icu Sedation ◽

Dose Dependent

Background: Dexmedetomidine is a highly selective α2-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Due to these ideal sedative properties, there has been increased interest in utilizing dexmedetomidine as a first-line sedative for critically ill patients requiring light sedation. Objective: To evaluate the ability to achieve goal intensive care unit (ICU) sedation before and after an institutional change of dosing from actual (ABW) to adjusted (AdjBW) body weight in obese patients on dexmedetomidine. Methods: This study included patients ≥ 18 years old, admitted to a surgical or medical ICU, required dexmedetomidine for at least 8 hours as a single continuous infusion sedative, and weighed ≥ 120% of ideal body weight. Percentage of RASS measurements within goal range (−1 to +1) during the first 48 hours after initiation of dexmedetomidine as the sole sedative agent or until discontinuation dosed on ABW compared to AdjBW was evaluated. Results: 100 patients were included in the ABW cohort and 100 in the AdjBW cohort. The median dosing weight was significantly higher in the ABW group (95.9 [78.9-119.5] vs 82.2 [72.1-89.8] kg; p = 0.001). There was no statistical difference in percent of RASS measurements in goal range (61.5% vs 69.6%, p = 0.267) in patients that received dexmedetomidine dosed based on ABW versus AdjBW. Conclusion: Dosing dexmedetomidine using AdjBW in obese critically ill patients for ongoing ICU sedation resulted in no statistical difference in the percent of RASS measurements within goal when compared to ABW dosing. Further studies are warranted.

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Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab263 ◽

2021 ◽

Author(s):

Stephen Duff ◽

Ruairi Irwin ◽

Jean Maxime Cote ◽

Lynn Redahan ◽

Blaithin A McMahon ◽

...

Keyword(s):

Critically Ill ◽

Cystatin C ◽

Critically Ill Patients ◽

Kidney Injury ◽

Adverse Outcomes ◽

Urinary Biomarkers ◽

High Morbidity ◽

Diagnostic Analysis ◽

Prognostic Analysis ◽

Stage 1

Abstract Background Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. Methods The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. Results In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. Conclusions Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.

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Impact of a white noise app on sleep quality among critically ill patients

Nursing in Critical Care ◽

10.1111/nicc.12742 ◽

2021 ◽

Author(s):

Evansaralin Warjri ◽

Fatima Dsilva ◽

Thankappan S. Sanal ◽

Abhishek Kumar

Keyword(s):

Sleep Quality ◽

White Noise ◽

Critically Ill ◽

Critically Ill Patients

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Effect of Ventilator Mode on Sleep Quality in Critically Ill Patients

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.200209-999oc ◽

2002 ◽

Vol 166 (11) ◽

pp. 1423-1429 ◽

Cited By ~ 184

Author(s):

Sairam Parthasarathy ◽

Martin J. Tobin

Keyword(s):

Sleep Quality ◽

Critically Ill ◽

Critically Ill Patients ◽

Ventilator Mode

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A Preliminary Study on the Utility of Root® with SedLine® for Sleep Evaluation in Critically Ill Patients: Comparison With Polysomnography and the Richards−Campbell Sleep Questionnaire

10.21203/rs.3.rs-31018/v1 ◽

2020 ◽

Author(s):

Kanae Nagatomo ◽

Masamitsu Sanui ◽

Tomoyuki Masuyama ◽

Yusuke Iizuka ◽

Jun Makino ◽

...

Keyword(s):

Sleep Quality ◽

Critically Ill ◽

Critically Ill Patients ◽

Medical Information ◽

University Hospital ◽

Nocturnal Sleep ◽

Subjective Sleep Quality ◽

Sleep Questionnaire ◽

Valid Instrument ◽

Restorative Sleep

Abstract Background To date, there has not been a practical evaluation of patient sleep in critical care units, where sleep disturbance is commonly found. This study aimed to validateฎ a portable electroencephalography monitor, as a sleep monitoring device, against polysomnography (PSG) for objective sleep evaluation and the Richards − Campbell Sleep Questionnaire (RCSQ) for subjective sleep quality in critically ill patients.Methods In this observational study, the sleep pattern of 10 adult patients staying in an ICU for at least 72 hours was evaluated for 24 hours using PSG and the Patient State Index (PSI) from SedLine. Additionally, their nighttime sleep was subjectively scored using the RCSQ to compare with the objective parameters.Results Sleep architecture from PSG showed an increase in light sleep and a prominent decrease in restorative sleep, despite preserved quantity of nocturnal sleep. Based on PSG results, PSI was distributed in accordance with sleep depth. Subjective quality of nocturnal sleep from the RCSQ was correlated with the PSI (r = -0.816, 95% confidence interval [CI]: -0.955 to -0.383), as well as with the nighttime stage N2 ratio from PSG alone (r = 0.741, 95% CI: 0.209 to 0.935) or combined with restorative sleep (r = 0.801, 95% CI: 0.347 to 0.951). The cutoff value of PSI to distinguish between the stage N1 and N2 was 67.0 (specificity, 0.641; sensitivity, 0.845 with area under curve [AUC] of 0.818).Conclusion SedLine is considered a feasible and valid instrument for sleep quality assessment in ICU patients.Trial registration: This investigation was part of an interventional trial registered with the University Hospital Medical Information Network Individual Clinical Trials Registry (UMIN-CTR000026350, http://www.umin.ac.jp/icdr/index-j.html) on March 1, 2017.

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