Sleep Disturbances and Fatigue in Critically Ill Patients

2011 ◽  
Vol 22 (3) ◽  
pp. 204-224 ◽  
Author(s):  
Ellyn E. Matthews
Keyword(s):  
Sleep Disturbance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Behavioral Interventions ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Management Options ◽  
Environmental Controls ◽  
Critically Ill Adults ◽  
The Impact

Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patient’s inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.

scholarly journals Effect of Peppermint Oil among Sleep Apnea Individuals

2020 ◽  
pp. 98-101
Author(s):  
C. Jayadharani ◽  
R. Gayatri Devi ◽  
A. Jothi Priya
Keyword(s):  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Well Being ◽  
Peppermint Oil ◽  
Positive Perception ◽  
Before And After ◽  
Age Limit ◽  
The Impact

Sleep disturbance or disruption is common among patients within the age limit 25-45. They often feel tired during the day time. During wakefulness which also causes sleep problems. Sleep disturbance associated with the sense of well-being, health, emotion regulation, and productivity, memory and cognitive functions. The main aim of this study is to prove the impact of peppermint oil on sleep apnea. The sample size of this study was 25 individuals and they were selected randomly. The peppermint oil is taken in a few amounts and massaged in the forehead while before sleeping. They were instructed to apply 2-3drops of oil on their forehead or spray on the pillow before going to bed. This has to be followed for 30 days. The sleeping hours and sleeping disturbances were recorded before and after using oil inhalation. Before the use of peppermint oil the sleeping hours was an average of 6.4±0.82 and after the use of peppermint oil the sleeping hours increased to an average of 7.1±1.03. Before the use of peppermint oil Sleep disturbances were of average 3.3±1.02 and after the use of peppermint oil the sleeping disturbances have been decreased to an average of 2.1±0.92. Data was collected and analysed using statistics. Peppermint oil has an effect on sleep apnea and it helps to overcome. From this study, it can be seen that a positive perception has been obtained towards the population.

Pathophysiology and therapeutic strategy for sleep disturbance in the ICU

2016 ◽  
Author(s):  
Louise Harder ◽  
Atul Malhotra
Keyword(s):  
Sleep Disturbance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sleep Apnoea ◽  
Mechanically Ventilated ◽  
Obstructive Sleep ◽  
Homeostatic Function ◽  
Poor Outcomes ◽  
Few Data ◽  
The Impact

Robust data have shown that sleep disruption and inadequate sleep duration in the general population impact neurocognitive function and produce cardiometabolic sequelae. Despite widespread recognition of the importance of sleep as an essential homeostatic function, there are relatively few data regarding the importance of sleep in critically-ill patients. Obstructive sleep apnoea is a common respiratory condition that is prevalent in the ICU and can be particularly problematic pre-intubation, post-extubation, and in the peri-operative setting. Considerable discussion regarding the impact of sleep versus sedation has occurred, with some insights emerging from improvements in our understanding of basic neurobiology. Sleep disturbance may also have an impact in critically-ill mechanically-ventilated patients by contributing to the development of delirium, which is associated with poor outcomes. However, further data are required to determine the ideal strategy to optimize sleep in the ICU and whether such strategies will in turn improve hard outcomes of critically-ill patients.

scholarly journals 0926 Examining Sleep In Parents And Children With Behavioral Or Clinical Sleep Disturbances

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A352-A352
Author(s):  
P Varma ◽  
M L Jackson ◽  
M Junge ◽  
R Conduit
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbance ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Poor Sleep ◽  
Clinical Group ◽  
Sleep Habits ◽  
Parents And Children ◽  
Sleep Arousal ◽  
The Impact

Abstract Introduction Sleep problems, such as insomnia are frequently reported in children. These sleep disturbances have either a behavioral (e.g. difficulties initiating or maintaining sleep) or clinical etiology (e.g. autism, asthma and T1 diabetes). Unlike clinical populations, outcomes in parents of children with behavioral sleep problems are underexamined. This study aimed to examine sleep in parents and children with behavioral or clinical sleep disturbances. Methods 290 parents (parents Mage = 35.9±5.2y, children Mage = 4.1± 2.3y) were recruited. Child’s sleep was reported using Child’s sleep habits questionnaire (CSHQ). Parent sleep was assessed using Pittsburgh sleep quality index (PSQI), Pre-sleep arousal scale (PSAS), and Glasgow sleep effort scale (GSES). A demographic question on the nature of child’s sleep disturbance was used to categorize parents into a) behavioral (n=206) or b) clinical group (n=84). Results Overall, 71% of parents and 67% of children had clinically significant sleep disturbance (PSQI ≥ 5 and CSHQ ≥ 41 respectively). Significant associations were observed between CSHQ and a) PSQI (r=0.47, p<.001), b) GSES (r=0.21, p<.001), and c) PSAS (r=0.46, p<.001). Step-wise regression reported that CSHQ was the strongest predictor of PSQI, accounting for 22% variance in scores (p<.001), followed by PSAS (7%). Independent groups t-tests found no differences in parents’ sleep quality (p=.06) and pre-sleep arousal (p=.38) between clinical and behavioral groups. However, 47% of parents in the clinical group took longer than 30 minutes to fall asleep, as opposed to 30% of parents in behavioral group (t(289)=-2.39, p=.01). Conclusion Parents report having poor sleep irrespective of the nature of child’s sleep difficulties. It is possible that parents in the clinical group may underreport their sleep problems due to increased attention towards child’s symptoms and diagnosis. Nevertheless, if any sleep related issues occur in children, the impact on parental sleep should be considered during assessment. Support N/A

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

631 Sleep SMART in Adolescents with Neurodevelopmental Disorders

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A247-A248
Author(s):  
Alyson Hanish ◽  
Abbey Jo Klein ◽  
Therese Mathews ◽  
Ann Berger ◽  
Kevin Kupzyk ◽  
...  
Keyword(s):  
Sleep Disturbance ◽  
Neurodevelopmental Disorders ◽  
Sleep Disturbances ◽  
Immediate Release ◽  
Sleep Time ◽  
Normative Values ◽  
Exogenous Melatonin ◽  
Contingency Contracting ◽  
Sleep Questionnaires ◽  
The Impact

Abstract Introduction: Introduction Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs. Methods: Methods Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary & urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination. Results: Results At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO & urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions. Conclusion: Conclusion Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST. Support (if any) Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).

scholarly journals Pharmacokinetic/Pharmacodynamic Target Attainment Based on Measured Versus Predicted Unbound Ceftriaxone Concentrations in Critically Ill Patients with Pneumonia: An Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 557
Author(s):  
Matthias Gijsen ◽  
Erwin Dreesen ◽  
Ruth Van Daele ◽  
Pieter Annaert ◽  
Yves Debaveye ◽  
...  
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Protein Binding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Cohort Study ◽  
Target Attainment ◽  
Binding Model ◽  
Observational Cohort ◽  
The Impact

The impact of ceftriaxone pharmacokinetic alterations on protein binding and PK/PD target attainment still remains unclear. We evaluated pharmacokinetic/pharmacodynamic (PK/PD) target attainment of unbound ceftriaxone in critically ill patients with severe community-acquired pneumonia (CAP). Besides, we evaluated the accuracy of predicted vs. measured unbound ceftriaxone concentrations, and its impact on PK/PD target attainment. A prospective observational cohort study was carried out in adult patients admitted to the intensive care unit with severe CAP. Ceftriaxone 2 g q24h intermittent infusion was administered to all patients. Successful PK/PD target attainment was defined as unbound trough concentrations above 1 or 4 mg/L throughout the whole dosing interval. Acceptable overall PK/PD target attainment was defined as successful target attainment in ≥90% of all dosing intervals. Measured unbound ceftriaxone concentrations (CEFu) were compared to unbound concentrations predicted from various protein binding models. Thirty-one patients were included. The 1 mg/L and 4 mg/L targets were reached in 26/32 (81%) and 15/32 (47%) trough samples, respectively. Increased renal function was associated with the failure to attain both PK/PD targets. Unbound ceftriaxone concentrations predicted by the protein binding model developed in the present study showed acceptable bias and precision and had no major impact on PK/PD target attainment. We showed suboptimal (i.e., <90%) unbound ceftriaxone PK/PD target attainment when using a standard 2 g q24h dosing regimen in critically ill patients with severe CAP. Renal function was the major driver for the failure to attain the predefined targets, in accordance with results found in general and septic ICU patients. Interestingly, CEFu was reliably predicted from CEFt without major impact on clinical decisions regarding PK/PD target attainment. This suggests that, when carefully selecting a protein binding model, CEFu does not need to be measured. As a result, the turn-around time and cost for ceftriaxone quantification can be substantially reduced.

A Systematic Review of Anticoagulation Strategies for Patients With Atrial Fibrillation in Critical Care.

2021 ◽  
Author(s):  
Alexandra Jayne Nelson ◽  
Brian W Johnston ◽  
Alicia Achiaa Charlotte Waite ◽  
Gedeon Lemma ◽  
Ingeborg Dorothea Welters
Keyword(s):  
Atrial Fibrillation ◽  
Critical Care ◽  
Critically Ill ◽  
Major Bleeding ◽  
Critically Ill Patients ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
The Impact ◽  
Anticoagulated Patients

Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically ill patients. There is a paucity of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. Our aim was to assess the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF. Methodology. A systematic literature search was conducted using MEDLINE, EMBASE, CENTRAL and PubMed databases. Studies reporting anticoagulation strategies for AF in adults admitted to a general critical care setting were assessed for inclusion. Results. Four studies were selected for data extraction. A total of 44087 patients were identified with AF, of which 17.8-49.4% received anticoagulation. The reported incidence of thromboembolic events was 0-1.4% for anticoagulated patients, and 0-1.3% in non-anticoagulated patients. Major bleeding events were reported in three studies and occurred in 7.2-8.6% of the anticoagulated patients and up to 7.1% of the non-anticoagulated patients. Conclusions. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies, between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear. Further data is required to facilitate an evidence-based assessment of the risks and benefits of anticoagulation for critically ill patients with AF.

scholarly journals Vascular access: the impact of ultrasonography

2016 ◽  
Vol 14 (4) ◽  
pp. 561-566 ◽  
Author(s):  
Carlos Eduardo Saldanha de Almeida ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Vascular Access ◽  
Critically Ill Patients ◽  
Albert Einstein ◽  
Sao Paulo ◽  
Future Studies ◽  
The Impact ◽  
Puncture Technique

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.

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