Temporal Disorganization of Circadian Rhythmicity and Sleep-Wake Regulation in Mechanically Ventilated Patients Receiving Continuous Intravenous Sedation

Gehlbach, Brian K.; Chapotot, Florian; Leproult, Rachel; Whitmore, Heidi; Poston, Jason; Pohlman, Mark; Miller, Amanda J.; Pohlman, Anne S.; Nedeltcheva, Arlet; Jacobsen, John Kurt; Hall, Jesse B.; Cauter, Eve Van

doi:10.5665/sleep.1998

Cited by 143 publications

(123 citation statements)

References 57 publications

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“…43,[70][71][72] Similarities between sleep and sedation include reduced responsiveness, reduced muscle tone, respiratory depression, and temperature deregulation. 49,50 However, sleep and sedation differ markedly. Sleep is a natural and essential biological process, with cyclical sleep architecture contributing to physiological restoration, whereas sedation is not natural and does not support normal sleep patterns.…”

Section: Reviewing the Evidencementioning

confidence: 99%

“…Limitations in the use of sleep assessment technology and communication challenges with critically ill patients contribute to the difficulty of measuring sleep in ICU patients. 49 What is known about sleep is that patients in the ICU have fragmented sleep, often experiencing multiple sleep-wake cycles that fail to reach N3 or restorative REM stage sleep. 43,44,50,51 The connection between sleep deprivation and delirium has particular importance in the ICU practice environment.…”

Section: Reviewing the Evidencementioning

confidence: 99%

“…45,48 Thus interrupting a patient's sleep every 60 minutes prevents a patient from achieving true restful sleep. 45,46 Several methods can be used to measure sleep (eg, polysomnography, electroencephalography, bispectral index, actigraphy) 45,46,49 in combination with or without direct observation and patients' self-reports. Limitations in the use of sleep assessment technology and communication challenges with critically ill patients contribute to the difficulty of measuring sleep in ICU patients.…”

Section: Reviewing the Evidencementioning

confidence: 99%

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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I n 2001, the Institute of Medicine challenged all health care professionals to decrease variation in practice through adoption of practice interventions based on best evidence to improve patients' outcomes.1 Current reviews of clinical practice suggest that only 10% to 15% of clinicians consistently implement evidence-based care 2 and indicate that it may take up to 2 decades for original research to be put into routine clinical practice.3 It is well established that evidence-based practice (EBP) is associated with higher quality care and better outcomes for patients than care that is steeped in tradition. 4 Yet at times, clinicians continue to practice on the basis of tradition.

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Section: Reviewing the Evidencementioning

confidence: 99%

Section: Reviewing the Evidencementioning

confidence: 99%

Section: Reviewing the Evidencementioning

confidence: 99%

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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“…In children with critical illness, sleep may play an even more important role in recovery. 3 Several studies [4][5][6] have indicated that both adult and pediatric ICU patients experience disturbances in circadian rhythm and decreases in slow-wave sleep. Although critically ill patients have multiple risk factors for sleep fragmentation, the most modifiable is the external environment, because sound and light levels play a key role in sleep-wake homeostasis.…”

mentioning

confidence: 99%

“…Although critically ill patients have multiple risk factors for sleep fragmentation, the most modifiable is the external environment, because sound and light levels play a key role in sleep-wake homeostasis. 2,[4][5][6][7] Disturbances in sleep continuity may be associated with an increased risk for delirium in patients admitted to the ICU. [8][9][10][11] Critical illness implies the need for invasive medical instrumentation and frequent interruptions for nursing care and monitoring.…”

mentioning

confidence: 99%

Nurses Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms

Kudchadkar¹,

Beers²,

Ascenzi³

et al. 2016

American Journal of Critical Care

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Effectiveness of Melatonin for the Prevention of Intensive Care Unit Delirium

et al. 2019

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Study Objective Intensive care unit (ICU) delirium is an acute brain dysfunction that has been associated with increased mortality, prolonged ICU and hospital lengths of stay, and development of post‐ICU cognitive impairment. Melatonin may help to restore sleep and reduce the occurrence of ICU delirium. The purpose of this study was to evaluate the effectiveness of melatonin for the prevention of ICU delirium in critically ill adults. Design Retrospective, observational cohort study. Setting Large academic medical center. Patients A total of 232 adults were included who were admitted to the medical‐surgical or cardiac ICUs between 2013 and 2017 who had a negative Confusion Assessment Method for the ICU (CAM‐ICU). Of those, patients who received melatonin for at least 48 hours were included in the melatonin group (n=117). Patients were included in the control group if they were admitted to the ICU for at least 4 days (average time of melatonin initiation) and did not receive melatonin or antipsychotics within the first 4 days of their ICU stay (n=115). Measurements and Main Results The primary outcome was development of delirium, which was assessed by using the CAM‐ICU twice daily by nursing staff. The development of delirium was significantly lower in the melatonin group: 9 (7.7%) versus 28 (24.3%) patients (p = 0.001). This finding remained significant in multivariate logistic models controlling for age, sex, history of hypertension, need for emergent surgery, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, ICU length of stay, dexmedetomidine use, and benzodiazepine use. For those patients who developed delirium, patients in the control group had, on average, 20.9 delirium‐free days without coma in 28 days compared with 19.9 days in the melatonin group (p = 0.72). In the melatonin group, melatonin was used for a mean ± SD of 6.3 ± 7.9 days, with a median dose of 3.5 mg/night (range: 1–10 mg). Conclusion The development of ICU delirium was significantly lower in the melatonin group compared with that in the control group. To our knowledge, this is one of the only studies that has examined the use of melatonin for the prevention of ICU delirium. Melatonin may be a promising agent for the prevention of ICU delirium; however, a randomized study is needed to further validate its efficacy.

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Temporal Disorganization of Circadian Rhythmicity and Sleep-Wake Regulation in Mechanically Ventilated Patients Receiving Continuous Intravenous Sedation

Cited by 143 publications

References 57 publications

Examining the Evidence to Guide Practice: Challenging Practice Habits

Examining the Evidence to Guide Practice: Challenging Practice Habits

Nurses Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms

Effectiveness of Melatonin for the Prevention of Intensive Care Unit Delirium

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