Adverse Environmental Conditions in the Respiratory and Medical ICU Settings

Meyer, Thomas J.; Eveloff, Scott E.; Bauer, Mark S.; Schwartz, William A.; Hill, Nicholas S.; Millman, Richard P.

doi:10.1378/chest.105.4.1211

Cited by 239 publications

(182 citation statements)

References 27 publications

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“…This finding contradicts much of the current literature, which suggests that noise is the major ICU factor responsible for sleep disruption. 3,16,[25][26][27][28][29][30] As suggested before, 12 noise may cause arousal, but not awakening, leading to sleep fragmentation and poor sleep quality. Patients who were never fully awakened from sleep may not however have been able to recall the etiology of their fragmented sleep.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

157

120

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Introduction: Sleep disturbance is a frequently overlooked complication of intensive care unit (ICU) stay. Aim: To evaluate sleep quality among patients admitted to ICU and investigate environmental and non-environmental factors that affect sleep quality in ICU. Methods: Over a 22-month period, we consecutively recruited patients who spent ≥ 2 nights post-endotracheal extubation in ICU and who were orientated to time, place, and person on the day of discharge. Self-reported sleep quality, according to a modifi ed Freedman questionnaire, which provided data on self-reported ICU sleep quality in ICU and environmental factors affecting sleep quality in the ICU, were collected. We also investigated non-environmental factors, such as severity of illness, ICU interventions, and medications that can affect sleep quality. Results: Fifty males and 50 females were recruited with a mean (± SD) age of 65.1 ± 15.2 years. APACHE II score at admission to ICU was 18.1 ± 7.5 with duration of stay 6.7 ± 6.5days. Self-reported sleep quality score at home (1 = worst; 10 = best) was 7.0 ± 2.2; this decreased to 4.0 ± 1.7 during their stay in ICU (p < 0.001). In multivariate analysis with APACHE III as severity of illness (R 2 = 0. S C I E N T I F I C I N V E S T I G A T I O N SA frequently overlooked complication of intensive care unit (ICU) admission is a lack of adequate sleep. In critically ill patients the prevalence of sleep disturbance has been shown to be more than 50%.1 Disrupted sleep is associated with immune system dysfunction, impaired resistance to infection, alterations in nitrogen balance, impaired wound healing, and cardiorespiratory and neurological consequences.2 Several polysomnographic studies have demonstrated decreased total sleep time, sleep fragmentation, and altered sleep architecture in patients in ICU.3-10 When examining the etiologies of sleep disturbance, these studies have focused on environmental stimuli such as increased noise.11 However, increased ICU noise level as the sole cause of sleep deprivation has been questioned.12-14 Frequent interruptions for diagnostic tests and routine patient care may also cause frequent arousals from sleep. In addition to environmental causes of poor sleep, sleep disturbance may also be related to non-environmental factors, including the condition at presentation (e.g., chronic obstructive pulmonary disease, pulmonary edema, myocardial infarction, postoperative state), disease or illness severity, patient discomfort, 2,4,5,10,15,16 patient medications (home medications) prior to admission, particularly those prescribed for insomnia and anxiety or depression, ICU interventions such as ventilators (invasive and noninvasive), dialysis, intra-aortic balloon counter pulsation (IABP) and the drugs administered in ICU. We therebRIEF SUMMARY Current Knowledge/Study Rationale: Environmental factors are known to affect quality of sleep in ICU. Study Impact: In addition to previously established environmental factors, several non-environmental factors were identifi ed which were...

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

157

120

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“…No Um ambiente ruidoso dificulta um descanso confortável causando nos pacientes perturbação do sono, alterações psicológicas com desorientação e até mesmo ansiedade nas enfermeiras mais susceptíveis 9,21,26 . Além disso, a exposição a ruído intenso pode trazer alterações fisiopatológicas no sistema cardiovascular e, possivelmente, transtornos no ritmo circadiano 27,28 .…”

Section: Discussionunclassified

Qualificação e quantificação da exposição sonora ambiental em uma unidade de terapia intensiva geral

Pereira

Toledo

Amaral

et al. 2003

Rev. Bras. Otorrinolaringol.

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Os níveis de ruído hospitalares encontram-se excessivamente elevados, especialmente no ambiente de UTI, em decorrência dos inúmeros alarmes e equipamentos, além da conversação da própria equipe hospitalar. Diante disso, esse ambiente, que deveria ser silencioso e tranqüilo, torna-se ruidoso, transformando-se em um grande fator de estresse e podendo gerar distúrbios fisiológicos e psicológicos tanto nos pacientes como nos funcionári-os dessa unidade. Objetivo: O objetivo deste estudo foi verificar o nível de pressão sonora equivalente em uma UTI geral, procurando estabelecer o período de maior exposição e comparando os resultados com as recomendações nacionais e internacionais. Forma de estudo: Estudo observacional. Material e Método: Medição do ruído ambiental da UTI do Hospital São Paulo através do analisador de ruído modelo 2260 (Brüel & Kjaer), em período total de 6.000 minutos e aferições a cada 27 segundos, configurado da seguinte forma: tempo de resposta rápido (Fast), medindo em decibel o nível de pressão sonora e usando a ponderação em freqüência A, de setembro de 2001 a junho de 2002 e sem o conhecimento dos funcionários do setor. Resultados: O nível de pressão sonora equivalente (L eq ) apresentou média de 65,36 dB(A) variando de 62,9 a 69,3 dB(A). Durante o período diurno a média do L eq foi de 65,23 dB(A) e para o período noturno, 63,89 dB(A). O L FMax encontrado foi de 108,4 dB(A) e o L FMin de 40 dB(A). Conclusões: O nível de ruído encontrado nessa UTI está acima do recomendado pela literatura em todos os períodos analisados. Dessa forma, as fontes produtoras de ruído excessivo precisam ser melhor identificadas para que possam ser tomadas as devidas medidas para atenuação desse ruído e tornar esse ambiente um local mais silencioso, beneficiando a função laborativa dos profissionais e a recuperação dos pacientes.

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“…Environmental stimuli are proposed to be the most disruptive factors to achieving sleep in the hospital (Aaron J. et al, 1996;Bentley S. et al, 1977;Meyer T. et al, 1994;Topf M, 1992;Topf M. et al, 1993;Cropp A. et al, 1994;Woods N. et al, 1974). The environmental stimulus most often cited in the literature to disturb sleep is noise (Bentley S. et al, 1977;Meyer T. et al, 1994).…”

Section: Discussionmentioning

confidence: 99%

Relation between Quality and Quantity of Sleep and Psychological Distress among Hospitalized Patients

Rajput¹,

Aslam²,

Yousaf³

et al. 2016

Ann. psychophysiol.

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Background Sleep is a fundamental component of good health, however its promotion in acute hospital settings does not appear to be a priority. Causes of sleep disruption are varied and include environmental and bio-cognitive factors, including pain, bright light, noise, anxiety and stress. The environmental and bio-cognitive consequences of sleep deprivation on the health and recovery of hospital inpatients are various. Inadequate sleep can lead to both psychological and physiological consequences. Objective This observational study was aimed at determining the pattern, quantity and quality of sleep and the prevalence, causes and effect of sleep deprivation / disturbance among patients hospitalized at the elective wards of a tertiary care hospital. Methods This observational study was conducted from August 2015 to January 2016, upon a sample of 50 patients admitted to Liaquat University Hospital (who had spent at least 4 weeks at the hospital). The sample of patients (chosen via simple random sampling), were interviewed consecutively every morning for 4 days and their mean response was evaluated to account for irregularities in experience. Data was collected using interview based structured questionnaire which included the 42 point DAS scale approved by Australian Center for Posttraumatic Mental Health. The data was analyzed in SPSS v. 17.0 and MS Excel 2013. Results During the stay at the hospital, DAS score of depression, anxiety and stress all rose. The most reported bothersome elements that disturbed sleep included, pain (30%), Noise (6%), and feeling of unease, irritation and panic (6%). Majority of the sample comprised of female (56%) respondents coming from rural areas (74%) with a low socioeconomic background (86%). The quantity of sleep dwindled between (but not more than) 5 to 6 hours. The quality too (self-rated by the respondents did not rise above a value of 6.5. Conclusion The conclusion is in line with our hypothesis. With the hustle and bustle happening at all hours in a hospital, patients have trouble getting adequate sleep, which has an evident the quality and quantity of sleep during their stay. Owing to the belief that sleep-deprived patients are less likely to be fully active participants in their care. It is recommended that steps should be taken to deal with this problem on a priority basis.

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Adverse Environmental Conditions in the Respiratory and Medical ICU Settings

Cited by 239 publications

References 27 publications

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Qualificação e quantificação da exposição sonora ambiental em uma unidade de terapia intensiva geral

Relation between Quality and Quantity of Sleep and Psychological Distress among Hospitalized Patients

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