Sleep in Hospitalized Patients

Hospitalized patients frequently have disordered and poor-quality sleep due to a variety of both intrinsic and extrinsic factors. These include frequent nighttime intrusions, insomnia related to pain and unfamiliar environments, dark conditions during the day with loss of natural light, and disruption of the natural sleep cycle due to illness. Sleep wake disturbances can result in a deleterious consequence on physical, emotional, and cognitive status, which may impact patient satisfaction, clinical recovery, and hospital length of stay. Despite this, clinicians frequently fail to document sleep disturbances and are generally unaware of the best practices to improve sleep quality in the hospital. A PubMed search was conducted using the terms: (“sleep and hospitalized patients”) and (“sleep and hospitalization”) to review the published data on the topic of sleep in hospitalized medical patients. The search was limited to English-language articles published between 2000 and 2018. Subsequent PubMed searches were performed to clarify the data described in the initial search, including the terms “hospital sleep protocols,” “hospitalized patients sleep documentation,” and “hospitalized patients sleep quality”. The purpose of this review is to discuss sleep disturbances in hospitalized patients with a focus on causes of sleep disturbance, the effect of poor-quality sleep, high risk populations, considerations for surveillance and prevention, and pharmacologic and non-pharmacologic options for treatment.

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Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Annals of Nutrition and Metabolism ◽

10.1159/000477675 ◽

2017 ◽

Vol 71 (1-2) ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Emilia Gómez-Hoyos ◽

Martín Cuesta ◽

Nayade Del Prado-González ◽

Pilar Matía ◽

Natalia Pérez-Ferre ◽

...

Keyword(s):

Body Mass Index ◽

Mortality Rate ◽

Parenteral Nutrition ◽

Demographic Data ◽

Tertiary Hospital ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Control Subjects ◽

Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

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562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.756 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S346-S346

Author(s):

Sarah Norman ◽

Sara Jones ◽

David Reeves ◽

Christian Cheatham

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Hospital Mortality ◽

Primary Outcome ◽

Fungal Infections ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Matched Design ◽

Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018190 ◽

2018 ◽

Vol 8 (3) ◽

pp. e018190 ◽

Cited By ~ 18

Author(s):

Marcel Émond ◽

Valérie Boucher ◽

Pierre-Hugues Carmichael ◽

Philippe Voyer ◽

Mathieu Pelletier ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Cohort Study ◽

Length Of Stay ◽

Hospital Length ◽

Cognitive Status ◽

Hospital Ward ◽

Hospital Length Of Stay ◽

Multicentre Cohort Study ◽

Multicentre Cohort

ObjectiveWe aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment.DesignThis is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward.SettingThe study took place in four Canadian EDs.Participants338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent.Main outcome(s) and measure(s)The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes.ResultsMean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient.ConclusionsAn incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.

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Insulin Regimens to Treat Hyperglycemia in Hospitalized Patients on Nutritional Support: Systematic Review and Meta-Analyses

Annals of Nutrition and Metabolism ◽

10.1159/000481355 ◽

2017 ◽

Vol 71 (3-4) ◽

pp. 183-194 ◽

Cited By ~ 4

Author(s):

Marina Verçoza Viana ◽

Luciana Verçoza Viana ◽

Ana Laura Tavares ◽

Mirela Jobim de Azevedo

Keyword(s):

Length Of Stay ◽

Nutritional Support ◽

Randomized Clinical Trials ◽

Regular Insulin ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Insulin Regimen ◽

Nph Insulin ◽

Meta Analyses

Background: The best insulin regimen to treat hyperglycemia in hospitalized patients on nutritional support (NS) is unclear. Methods: We searched electronic databases to identify cohort studies or randomized clinical trials in order to evaluate the efficacy of different insulin regimens used to treat hyperglycemia in hospitalized patients on NS on diverse outcomes: mean blood glucose (MBG), hypoglycemia, length of stay in hospital, and mortality. Results: Seventeen studies from a total of 5,030 were included. Enteral Group included 8 studies; 1,203 patients using rapid, glargine, NPH, or Premix insulin; MBG 108-225 mg/dL; hypoglycemia 0-13%. In indirect meta-analyses, NPH insulin ranked best for glucose control (MD 95% CI -2.50 mg/dL [2.65 to -2.35]). Parenteral Group included 4 studies; 228 patients using regular and glargine or NPH insulin; MBG 137-202 mg/dL; hypoglycemia 0-40%. In meta-analyses comparing regular insulin added to parenteral nutrition bag with glargine, MBG (MD 95% CI -3.78 mg/dL [-11.93 to 4.37]; I2 = 0%) or hypoglycemia frequency (RR 95% CI 1.37 [0.43-4.32]; I2 = 70.7%) did not differ. The description related to hospital length of stay and mortality was inconsistent between groups. Conclusions: The best insulin regimen to treat hyperglycemia in hospitalized patients on NS has not been established; best results using insulin regimens with NPH in enteral nutrition do not seem to be clinically relevant.

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LITERATUR REVIEW: TERAPI NON FARMAKOLOGIS UNTUK MENINGKATKAN KUALITAS TIDUR PASIEN DI ICU ATAU CCU

Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing) ◽

10.33023/jikep.v7i2.847 ◽

2021 ◽

Vol 7 (2) ◽

pp. 337-343

Author(s):

Rizky Asta Pramestirini ◽

Heny Ekawati ◽

Suhariyati Suhariyati

Keyword(s):

Sleep Quality ◽

Music Therapy ◽

Sleep Disturbances ◽

Quality Measurement ◽

Human Needs ◽

Measurement Tools ◽

Quality Sleep ◽

Improve Sleep Quality ◽

Sound Reduction ◽

Switching Treatment

Abstract Sleep is one of the basic human needs. Good quality sleep can increase the improvement of the disease. Sleep disturbances are common among hospitalized patients in CCU and ICU. The purpose of this literature review is to compare several research results on non-pharmacological therapies (eye masks, earplugs, music therapy, turning off lights, environmental modifications) in improving sleep quality to determine the best nursing action and safe for treating sleep disorders patients. Search articles using the PICO framework in the database; Google Scholar, Ebscho, Science direct, Elseiver, MedLine, CINAHL, PubMed, and ProQuest, limited to the last 10 years; 2011 to 2021, 10 International Journals were obtained. Improved sleep quality can be done in several ways; the use of eye masks, earplugs, music therapy, light and sound reduction, switching treatment schedules outside of bedtime, and combinations. The results of the review show schedules outside of bedtime, and combinations. The results of the review show that the most effective actions applied locally to improve sleep quality are reducing lighting and noise and diverting treatment schedules outside of bedtime because it is easy, safe, and does not cost money. If the intervention has not helped, eye masks, earplugs, and/or music can be offered according to the patient's choice, local culture, and facilities available at the hospital. Further research is needed on patients outside the ICU/CCU with a larger number of samples, different age and condition characteristics, longer treatment duration, and using objective sleep quality measurement tools such as polysomnography.

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No associations between physical activity and clinical outcomes among hospitalized patients with severe COVID-19

10.1101/2020.11.25.20237925 ◽

2020 ◽

Author(s):

Ana J. Pinto ◽

Karla F. Goessler ◽

Alan L. Fernandes ◽

Igor H. Murai ◽

Lucas P. Sales ◽

...

Keyword(s):

Physical Activity ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Clinical Outcomes ◽

Hospital Length ◽

Sao Paulo ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Activity Levels ◽

Physical Activity Levels

AbstractPurposeThis small-scale, prospective cohort study nested within a randomized controlled trial aimed to investigate the possible associations between physical activity levels and clinical outcomes among hospitalized patients with severe COVID-19.MethodsHospitalized patients with severe COVID-19 were recruited from Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital), and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. Physical activity levels were assessed by Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were: mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsMean hospital length of stay was 8.5 ± 7.1 days; 3.3% of patients died, 13.8% were admitted to ICU, and 8.6% required mechanical ventilation. Linear regression models showed that physical activity indexes were not associated with hospital length of stay (work index: β=-0.57 [95%CI: −1.80 to 0.65], p=0.355; sport index: β=0.43 [95%CI: −0.94 to 1.80], p=0.536; leisure-time index: β=1.18 [95%CI: −0.22 to 2.59], p=0.099; total activity index: β=0.20 [95%CI: −0.48 to 0.87], p=0.563. Physical activity indexes were not associated with mortality, admission to ICU and mechanical ventilation requirement (all p>0.05).ConclusionsAmong hospitalized patients with COVID-19, physical activity did not associate with hospital length of stay or any other clinically-relevant outcomes. These findings suggest that previous physical activity levels may not change the prognosis of severe COVID-19.

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Functional Impairment, Symptom Burden, and Clinical Outcomes Among Hospitalized Patients With Advanced Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2019.7385 ◽

2020 ◽

Vol 18 (6) ◽

pp. 747-754 ◽

Cited By ~ 1

Author(s):

Daniel E. Lage ◽

Areej El-Jawahri ◽

Charn-Xin Fuh ◽

Richard A. Newcomb ◽

Vicki A. Jackson ◽

...

Keyword(s):

Length Of Stay ◽

Functional Status ◽

Clinical Outcomes ◽

Advanced Cancer ◽

Functional Impairment ◽

Symptom Burden ◽

Hospital Length ◽

Hospitalized Patients ◽

Assessment System ◽

Hospital Length Of Stay

Background: National guidelines recommend regular measurement of functional status among patients with cancer, particularly those who are elderly or high-risk, but little is known about how functional status relates to clinical outcomes among hospitalized patients with advanced cancer. The goal of this study was to investigate how functional impairment is associated with symptom burden and healthcare utilization and clinical outcomes. Patients and Methods: We conducted a prospective observational study of patients with advanced cancer with unplanned hospitalizations at Massachusetts General Hospital from September 2014 through March 2016. Upon admission, nurses assessed patients’ activities of daily living (ADLs; mobility, feeding, bathing, dressing, and grooming). Patients with any ADL impairment on admission were classified as having functional impairment. We used the revised Edmonton Symptom Assessment System (ESAS-r) and Patient Health Questionnaire-4 to assess physical and psychological symptoms, respectively. Multivariable regression models were used to assess the relationships between functional impairment, hospital length of stay, and survival. Results: Among 971 patients, 390 (40.2%) had functional impairment. Those with functional impairment were older (mean age, 67.18 vs 60.81 years; P<.001) and had a higher physical symptom burden (mean ESAS physical score, 35.29 vs 30.85; P<.001) compared with those with no functional impairment. They were also more likely to report moderate-to-severe pain (74.9% vs 63.1%; P<.001) and symptoms of depression (38.3% vs 23.6%; P<.001) and anxiety (35.9% vs 22.4%; P<.001). Functional impairment was associated with longer hospital length of stay (β = 1.29; P<.001) and worse survival (hazard ratio, 1.73; P<.001). Conclusions: Hospitalized patients with advanced cancer who had functional impairment experienced a significantly higher symptom burden and worse clinical outcomes compared with those without functional impairment. These findings provide evidence supporting the routine assessment of functional status on hospital admission and using this to inform discharge planning, discussions about prognosis, and the development of interventions addressing patients’ symptoms and physical function.

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