ICU Literature Updates

Prevalence of obstructive sleep apnoea in acute coronary syndrome: Routine screening in intensive coronary care units

OSA is frequently found in the acute phase of ischaemic heart disease and its presence is associated with more severe ACS and a poorer left ventricle systolic function.

https://www.ncbi.nlm.nih.gov/pubmed/28647057

Association between Obstructive Sleep Apnea and Acute Kidney Injury in Critically Ill Patients: A Propensity-Matched Study

The history of OSA diagnosed by polysomnography is associated with higher risk of AKI in critically ill patients.

https://www.ncbi.nlm.nih.gov/pubmed/27951537

Melatonin Secretion Pattern in Critically Ill Patients: A Pilot Descriptive Study

Authors: Boyko Y, Holst R, Jennum P, Oerding H, Nikolic M, Toft P.

In this pilot descriptive study, melatonin secretion pattern in conscious, critically ill patients on mechanical ventilation was found to follow a diurnal but phase-delayed curve. Remifentanil infusion did not affect melatonin secretion but was associated with lower risk of atypical sleep.

https://www.ncbi.nlm.nih.gov/pubmed/28584667

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.

https://www.ncbi.nlm.nih.gov/pubmed/27159066

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.

http://www.ncbi.nlm.nih.gov/pubmed/26210193

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.

http://www.ncbi.nlm.nih.gov/pubmed/26304279

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.

http://www.ncbi.nlm.nih.gov/pubmed/26487127

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.

http://www.ncbi.nlm.nih.gov/pubmed/26439374

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.

http://www.ncbi.nlm.nih.gov/pubmed/25881268

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.

http://www.ncbi.nlm.nih.gov/pubmed/25969139