ICU Literature Updates from March 2014

Typical Sleep Patterns Are Absent in Mechanically Ventilated Patients and Their Circadian Melatonin Rhythm is Evident But the Timing is Altered by the ICU Environment

The authors performed a prospective observational study of 25 mechanically ventilated and sedated patients admitted to a North American ICU. The study investigators evaluated whether circadian and homeostatic processes were functioning normally and appropriately in these patients in order to maintain normal sleep–wake patterns. The authors discovered that these patients appear to have a “free running circadian pacemaker”. The investigators found that EEG activity demonstrated slow wave sleep that was similarly distributed during the 24 hour period of evaluation, indicating absence of changes between wake and sleep states. This study highlights the importance of providing an ICU environment that promotes a normal circadian rhythm.

Nurses Perceptions of Sleep in the Intensive Care Unit Environment: A Literature Review

In this study, the authors hypothesized that frequent assessment by nurses may lead to nursing being the multidisciplinary team members most at risk for impacting the critically ill patients ability to sleep. Through a review of the literature, the authors evaluated the nurses’ knowledge and prioritization of sleep; their understanding of sleep assessment skills and tools; the effects of nursing interventions upon the sleep experience; the implementation of acupuncture a complimentary therapy to aid sleep. 25 articles meet the inclusion criteria as determined by the authors. The authors concluded, “ICU nurses lack a complex understanding of the importance of sleep and interventions needed to promote it.” They site insufficient training and lack of protocols within nursing practice as contributing factors. These important findings can serve as a stimulus to provide nursing with better training and tools to assess and improve sleep in ICU patients.