Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality

Boyko, Yuliya; Toft, Palle; Ørding, Helle; Lauridsen, Jørgen; Nikolic, Miki; Jennum, Poul

doi:10.1007/s11325-018-1718-3

Cited by 29 publications

(21 citation statements)

References 21 publications

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“…Moreover, the lack of K-complexes or sleep spindles has been shown to be significantly associated with higher mortality in ICU patients. 108 Poor sleep quality is frequently named as one of the top stressors for ICU patients. [109][110][111][112] Light is the most critical external regulating factor of the circadian clock.…”

Section: Light the Role Of Light In Critical Illnessmentioning

confidence: 99%

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Luetz

Grunow

Mörgeli

et al. 2019

Semin Respir Crit Care Med

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Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in “Post-ICU Syndrome” (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep–wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects. The main areas affected by most architectural and interior design modifications are sound environment, light control, floor planning, and room arrangement. Implementation of corresponding solutions is challenging considering the significant medical and technical demands of ICUs. This article discusses innovative concepts and promising approaches in ICU design that may be used to prevent stress and to support the healing process of patients, potentially limiting the impact of delirium and PICS.

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Section: Light the Role Of Light In Critical Illnessmentioning

confidence: 99%

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Luetz

Grunow

Mörgeli

et al. 2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…K-complexes are generated in the cerebral cortex, and sleep spindles are generated by the reticular nucleus of the thalamus. 4,13 K-complexes and sleep spindles mark the transition from N1 to N2 sleep and suppress activation of the cortical networks involved in alertness. K-complexes and sleep spindles have been The absence of sleep spindles and K-complexes is associated with mortality.…”

Section: Changes In Non-rem and Rem Sleep In The Icumentioning

confidence: 99%

“…13,14 Researchers who examined the EEG characteristics of patients in the ICU during non-REM sleep reported that patients in the ICU may not demonstrate K-complexes and sleep spindles, and they found that the absence of K-complexes and sleep spindles was associated with an elevated mortality risk. 4 The inability to produce these EEG features could indicate dysfunction of the corticothalamic networks that generate these rhythms, which may be caused by brain injuries or the effects of ICU therapies and medications.…”

Section: Changes In Non-rem and Rem Sleep In The Icumentioning

confidence: 99%

Sleep Neurobiology and the Critical Care Environment

Fink

2020

Critical Care Nurse

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Topic Sleep in the intensive care unit can be poorly consolidated and highly fragmented. This review examines the neurobiology of normal and abnormal sleep, with a focus on the changes that occur in the intensive care unit environment. Clinical Relevance Patients in the intensive care unit demonstrate a lack of rapid-eye-movement sleep and an inability to effectively transition from light to deep stages of sleep. These abnormalities can adversely affect hemodynamic parameters and physiological and psychological outcomes. Purpose To describe the brain mechanisms and electroencephalographic characteristics of wakefulness and the different stages of sleep. This review also describes how sleep can be altered by hospitalization in the intensive care unit and how nurses can design interventions that improve sleep and outcomes. Content Covered The review examines sleep mechanisms, including brain electrical activity, regulatory centers in the brain, and circadian and diurnal patterns of sleep and hemodynamic function. Nursing interventions for specific patient risk factors in the intensive care unit are proposed.

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“…It causes abnormalities in immune and metabolic endocrine functions, which play crucial roles in critically ill patients [ 4 , 5 ]. Additionally, it may be associated with the occurrence of delirium [ 6 ], noninvasive ventilation failure [ 7 ], and increased mortality [ 8 ]. Consequently, recent clinical guidelines have indicated the need for research methods to improve sleep [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study

et al. 2021

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Background The clinical effect of enteral administration of sleep-promoting medication (SPM) in mechanically ventilated patients remains unclear. This study aimed to investigate the relationship between enteral SPM administration and the intravenous sedative dose and examine the safety and cost of enteral SPM administration. Methods This single-center retrospective cohort study was conducted in a Japanese tertiary hospital intensive care unit (ICU). The exposure was enteral SPM administration during mechanical ventilation. The outcome was the average daily propofol dose per body weight administered as a continuous sedative during mechanical ventilation. Patients were divided into three groups based on the timing of SPM administration at ICU admission: “administration within 48 hours (early administration [EA]),” “administration after 48 hours (late administration [LA]),” and “no administration (NA).” We used multiple linear regression models. Results Of 123 included patients, 37, 50, and 36 patients were assigned to the EA, LA, and NA groups, respectively. The average daily propofol dose per body weight was significantly lower in the EA group than in the LA and NA groups (β -5.13 [95% confidence interval (CI) -8.93 to -1.33] and β -4.51 [95% CI -8.59 to -0.43], respectively). Regarding safety, enteral SPM administration did not increase adverse events, including self-extubation. The total cost of neuroactive drugs tended to be lower in the EA group than in the LA and NA groups. Conclusions Early enteral SPM administration reduced the average daily propofol dose per body weight without increasing adverse events.

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Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality

Abstract: The presence of atypical sleep and absence of normal PSG sleep characteristics in conscious critically ill patients on mechanical ventilation indicates involvement of sleep producing brain structures in the pathological process and is associated with poor outcome.

Cited by 29 publications

References 21 publications

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Sleep Neurobiology and the Critical Care Environment

Effect of enterally administered sleep-promoting medication on the intravenous sedative dose and its safety and cost profile in mechanically ventilated patients: A retrospective cohort study

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