ICU Literature Updates from March 2015

Delirium Transitions in the Medical ICU: Exploring the Role of Sleep Quality and Other Factors

In this article, the authors evaluate the elusive link between delirium and sleep deprivation in 223 medical ICU patients over a 201 day period. Patient were also assessed for delirium on a regular basis. Using the Richards-Campbell Sleep Questionnaire, daily perceived sleep quality ratings were measured. Delirium was measured twice a day with the Confusion Assessment Method tool (CAM) for the ICU. In this study, perceived sleep quality was similar in ICU patients who developed delirium and those who did not. Additionally, perceived sleep quality was unrelated to delirium transition. This is another piece of work that fails to establish a link between delirium and sleep deprivation.

Sleep in the Intensive Care Unit

In this review, from one of the nation’s centers for evaluating sleep in the ICU, Dr. Pisani and colleagues offer a concise update on developments in critical care medicine pertaining to sleep. Specifically, the authors provide a very nice discussion on circadian rhythm in critical illness and a good review of potentially modifiable disruptors to sleep such as noise, patient care activities and light. Additionally, the authors give very helpful descriptions with different methods of analysis of EEG enabling the reading to better understand EEG interpretation for sleep evaluation in ICU patients. Overall this is a welcomed addition to the growing body of review articles focusing on sleep in the ICU.

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

In the article, the researchers evaluate sleep in the ICU after initiating a multimodal approach to improving sleep. The investigators enrolled 12 patients who were admitted in a neurological ICU. Sleep promoting interventions such as environmental light (eye mask) and noise reduction (headphones) were implemented as well as prescribing melatonin. Unfortunately, for many patients, EEG recordings could not be interpreted. In those patients who recordings could be obtained, the authors found no difference between intervention and non-intervention groups.