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Promoting Sleep in the ICU

Promoting Sleep in the ICU

Delirium in the ICU has been well studied and is associated with poor patient outcomes. Other studies have suggested that few patients in the ICU get adequate sleep for a variety of reasons. The link between lack of sleep and delirium, however, has not been evaluated in ICU patients. Additionally, most studies to improve sleep quality have been small or adopted a single-faceted approach. Taking a Multifaceted Approach For a study published in Critical Care Medicine, my colleagues and I implemented a multifaceted intervention to improve sleep quality—and therefore reduce delirium—in the medical ICU. Perceived sleep quality was assessed daily for every patient during a usual care stage and during three inter­vention stages: Stage 1: Environmental interventions. At night, ICU staff was encouraged to turn off room and hallway lights, turn off televisions, minimize unnecessary alarms, pull curtains, close doors, and minimize unnecessary patient room visits. Overhead paging was virtually eliminated by encouraging clerks to deliver messages face-to-face. Daytime interventions to maintain circadian rhythms included raising blinds, encouraging patient mobilization, and minimizing caffeine in the late afternoon. Stage 2: Non-pharmacologic interventions. Ear plugs, eye masks, and tranquil music were used to promote sleep but only in patients who willingly accepted these interventions. Stage 3: Pharmacologic guideline. A guideline was developed and provided to physicians and nurses encouraging use of medications that could promote restorative sleep. The guideline also discouraged use of drugs that could impair restorative sleep and precipitate delirium. Encouraging Results Findings from our analysis showed that perceived sleep quality improved, but not to a statistically significant degree. However, the sleep-promoting interventions led to significant improvements in perceived...
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