ICU Literature Updates from November 2015

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.