The primary mission of any intensive care unit (ICU) is to provide critically ill patients with high-quality care and an atmosphere in which to recuperate. However, all too often, the intensive environment, which is often busy, chaotic, and noisy, may contribute to just the opposite. Patients overstimulated with noise, lights, and other distractions often suffer from sleep deprivation. Research in medicine and nursing has shown that sleep deprivation can have detrimental effects on an ailing patient. Therefore, a quiet time program was developed in the neuro-ICU to reduce noise and light levels, with the ultimate goal to allow sleep. Quiet time, a period of reduced controllable noise and light, took place twice daily coinciding with circadian rhythms. The study included 50 neuro-ICU patients, 35 observed during day hours and 15 observed during night hours. Noise and light levels were measured at multiple locations before, during, and after quiet time hours. Patients' sleep behavior was recorded every half hour, beginning 1/2 hour before quiet time until 30 minutes after. Analysis of data, adjusted for multiple testing and repeated measures on patients, demonstrated significantly lower noise and light levels during day shift quiet time. In addition, patients were significantly more likely to be observed sleeping during day shift quiet time hours.

In the critical care setting, the focus of care during the first few weeks following acute brain injury is prevention of secondary brain injury by optimizing cerebral perfusion. Ensuring adequate oxygenation and perfusion of cerebral tissues requires attention to all of the body systems. Chest percussion therapy (CPT) promotes pulmonary hygiene and optimizes gas exchange by opening the alveoli. However, many patients with brain injury have intracranial pressure (ICP) monitoring, and conventional wisdom supports limiting activities such as CPT that may stimulate the patient and increase ICP. The purpose of this study was to explore the effects of CPT on ICP. Thirty participants were enrolled over a 6-month period. Data were collected at 1-minute intervals for 1 hour. Each patient was randomized to receive automated CPT (using specialty beds) for 10 minutes, starting at 10, 20, 30, or 40 minutes into the hour. There were no differences in mean ICP values before, during, or after CPT. This study provides evidence that it is safe to perform CPT in patients with ICP monitoring in situ. Pathophysiology of Brain InjuryBrain injury may result from external trauma, stroke, tumors, or other intracranial insult. Worldwide, brain injury is the leading cause of death and disability. In the United States, it has reached epidemic proportions. Each year, nearly 1.4 million Americans sustain a traumatic brain injury; 235,000