ICU Literature Updates

The Feasibility and Utility of Continuous Sleep Monitoring in Critically Ill Patients Using a Portable Electroencephalography Monitor

This study suggests the utility of a portable EEG monitor to measure different sleep stages, transitions, and arousal in the ICU setting.

Routine Postoperative Monitoring After Bariatric Surgery in Morbidly Obese Patients with Severe Obstructive Sleep Apnea: ICU Admission is Not Necessary

In this study, the authors investigated the need for ICU admission after bariatric surgery. OSA has a known incidence of 70-80% in bariatric surgery patients. To prevent complications, many of these people are admitted to the ICU for observation. However, this could potentially increase overall cost of hospitalization and waste a scarce resource such as the ICU. Of the 794 patients in this study, 151 had severe sleep apnea and where admitted to the ICU. There were no deaths, re-intubations or other complications. The authors suggest, based on the findings in this study, that routine ICU use after laparoscopic bariatric surgery may be unnecessary.

Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit

In this manuscript, the authors provide a nice discussion on the reasons why patients in the ICU have sleep disorders and how these disorders manifest in critically ill patients. The authors provide an interesting discussion of how being admitted to the ICU promotes and perpetuates sleep disorders and provide a discussion on what can be done to possibly prevent sleep deterioration in the ICU. This is a very interesting read for those just getting into the interface between sleep and critical care medicine. Interested readers should also seek previous works by Dr. Pisani who is currently at one of the nation’s most productive research centers for sleep in the ICU.

The Influence of Care Interventions on the Continuity of Sleep of Intensive Care Unit Patients

In this small study of 12 patients, the authors evaluate the influence of care on sleep using filming techniques and actigraphy. The authors noted 28 different types of care interventions of which 42.8 percent caused awakening for sleep. The examination revealed that there were 1.8 interventions per patient per hour.  Administration of oral medications and food were the interventions that caused higher frequencies of awakenings.  Health care providers need to rethink planning of interventions to help aid sleep. They off a few suggestions on how an ICU could do this.

Non-pharmacological Interventions for Sleep Promotion in the Intensive Care Unit

In this extensive review, the authors examined 30 studies, many of which were randomized controlled trails,  that evaluated the effects of non-pharmacological interventions for sleep promotion in patients admitted to the ICU who were 18 years of age or older.  In these studies, there were at total of 1569 patients.  The authors we able to review many interventions and their effects on sleep. They concluded that the quality of existing evidence pertaining to using non-pharmacological interventions for promoting sleep on critically ill adult patients was low or very low. However, they did find that earplugs or eye mask may have a small benefit on sleep and delirium in the ICU.

Effects of Earplugs and Eye Masks Combined with Relaxing Music on Sleep, Melatonin and Cortisol Levels in ICU Patients: A Randomized Controlled Trial

In this study, the authors aimed to determine the effects of using earplugs and eye masks with relaxing background music on sleep, melatonin and cortisol levels in actual ICU patients. 50 cardiac ICU patients were randomized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in cardiac ICU. Perceived sleep quality was better in the intervention group. There were no group differences found in measuring urinary melatonin levels and cortisol levels for the night before surgery, and the first and second night post-surgery.

Melatonin Reduces the Need for Sedation in ICU Patients: A Randomized Controlled Trial

In this single center, double blind randomized placebo-controlled study, the authors sought to determine if nocturnal melatonin supplementation would reduce the need for sedation in critically ill patients. The authors discovered that melatonin treated patients received less sedation. Other neurological indicators (amount of some neuroactive drugs, pain, agitation, anxiety, sleep observed by nurses, need for restraints, need for extra sedation, nurse evaluation of sedation adequacy) seemed improved. Unfortunately ICU related PTSD did not seem get better with treatment.

Emerging Role of Melatonin and Melatonin Receptor Agonists in Sleep and Delirium in Intensive Care Unit Patients

In this review, the authors sought to investigate the impact of melatonin and melatonin receptor agonist on delirium prevention. The authors acknowledge the limitations of our understanding on what causes delirium but postulate that sleep deprivation plays a role. This is a timely and good review of the literature on the relationship between melatonin, sleep deprivation and delirium.

Sleep in the Neurological Intensive Care Unit: Feasibility of Quantifying Sleep After Melatonin Supplementation with Environmental Light and Noise Reduction

It is widely known that sleep deprivation can be detrimental to critically ill patients. In this investigation, the authors sought to determine the feasibility of quantifying sleep in 12 neurological ICU patients who had received melatonin. Patients were also subjected to light and environmental noise reduction. Like many previous studies, the authors found it hard to quantify sleep in ICU patients. Additionally, the authors discovered that total sleep time was normal, although sleep was fragmented and time spent in slow-wave or rapid eye movement sleep was notably decreased as has been discovered in many other studies. Unfortunately, the authors did not find a difference between the control and intervention group

The Use of Modafinil in the Intensive Care Unit

In this small case series, the authors address a several issues related to sleep deprivation in the ICU, namely fatigue, depression and excessive daytime somnolence. The investigators sought to determine the use of modafinil, a psycho-stimulant, could improve ICU outcomes by treating some of these conditions. They discovered that through the use of modafinil 200mg each morning patient had greater wakefulness, were able to participate in rehab more and got more sleep at night. This study will need to be repeated on a larger scale to help determine if modafinil can have a true impact on ICU outcomes.