Delirium Transitions in the Medical ICU

Abstract

Objective-Disrupted sleep is a common and potentially modifiable risk factor for delirium in the intensive care unit (ICU). As part of a quality improvement (QI) project to promote sleep in the ICU, we examined the association of perceived sleep quality ratings and other patient and ICU risk factors with daily transition to delirium.Design-Secondary analysis of prospective observational study. Setting-Medical ICU (MICU) over a 201-day period.Patients-223 patients with ≥1 night in the MICU in between two consecutive days of delirium assessment. Interventions-NoneMeasurements-Daily perceived sleep quality ratings were measured using the Richards Campbell Sleep Questionnaire (RCSQ). Delirium was measured twice-daily using the Confusion Assessment Method for the ICU (CAM-ICU Conclusions-We found no association between daily perceived sleep quality ratings and transition to delirium. Infusion of benzodiazepine and/or opioid medications was strongly associated with transition to delirium in the ICU in mechanically ventilated patients and is an important, modifiable risk factor for delirium in critically ill patients.

The Japanese version of the Richards‐Campbell Sleep Questionnaire: Reliability and validity assessment

“…This could be because the four people with subsyndromal delirium might have responded to the questions without fully understanding them, since their nighttime lucidity was low. In other words, subjective evaluation of sleep quality by these subclinical delirious patients may not have been reliable, which could be a potential confounding factor when In fact, a recent study evaluating sleep quality with questionnaires failed to show an association between sleep disturbance and delirium (Kamdar et al, 2015).…”

Protetores de ouvido e olhos na promoção do sono em cuidados intensivos

“…3 It is understood that the evidence that sleep disturbances in the patient admitted to intensive care are common and contribute to various adverse effects is increasingly clear and consistent.1,6 Of the adverse consequences associated with sleep, characterized by being reduced and fragmented, there is a greater tendency for intrinsic stress factors and a greater pre-disposition for delirium. 3,7 However, several authors report that sleep disorders in the critically ill patient contribute to other aspects detrimental to the recovery of critical illness. At a respiratory level, for example, there is a close relationship between sleep disorders and the decrease in inspiratory muscle performance that directly affects the weaning processes of mechanical ventilation and contributes to the increase of failure rates in mechanical ventilation.…”

“…for hospital daytime sound levels during daytime and night time periods, and the recommended limit is 40 decibels for sound peaks. [2][3][4][5][6][7][8][9][10][11] However, most studies evaluating sound levels in intensive care refer to 80-decibel sound peaks during regular practice of care. [1][2] The latest scientific evidence holds that, in enclosed spaces, a noise of 30 decibels and noise peaks 45 decibels may adversely affect sleep and result in sleep disturbances, and noise above 70 decibels may lead to vasoconstriction, increased heart rate, hypertension, and cardiac arrhythmias.…”

Intensive Care Unit Delirium

“…With regard to sedative and analgesic medications, use of lorazepam, midazolam, meperidine, and morphine are most strongly associated with a higher risk of delirium, likely due to their longer duration of actions and increased risk of drug accumulation with altered organ function (e.g., renal and hepatic insufficiency) compared to agents such as propofol, dexmedetomindine, and fentanyl. 13,14 Sedation with benzodiazepine infusions for mechanical ventilation, in particular, carries a higher risk of delirium compared to other sedative regimens, 20-22 as does deep levels of sedation when compared to light sedation. 20 Additionally, medications with anticholinergic properties (e.g., diphenhydramine, promethazine, cyclobenzaprine) can precipitate delirium, potentially through altered neurotransmission or reduced neuronal control of inflammation.…”

“…75 The authors subsequently found no association between daily perceived sleep quality rating and transition to delirium. 22 These studies suggest that maintaining practices conducive to sleep is important to prevent delirium in the ICU but highlight the difficulty in monitoring sleep and differentiating between sleep perception and measures of actual sleep.…”