ICU Literature Updates from July 2015

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.