Litton Edward, Elliott Rosalind, Thompson Kelly, Watts Nicola, Seppelt Ian, Webb Steven A R
1Intensive Care Unit, St John of God Hospital, Subiaco, Perth, Western Australia, Australia. 2School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia, Australia. 3Intensive Care Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia. 4Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales, Australia. 5Sydney Medical School-Nepean, University of Sydney, Sydney, New South Wales, Australia. 6St John of God Hospital, Subiaco, Perth, Western Australia, Australia. 7Monash University, Melbourne, Victoria, Australia.
Crit Care Med. 2017 Jun;45(6):966-971. doi: 10.1097/CCM.0000000000002405.
To use clinically accessible tools to determine unit-level and individual patient factors associated with sound levels and sleep disruption in a range of representative ICUs.
A cross-sectional, observational study.
Australian and New Zealand ICUs.
All patients 16 years or over occupying an ICU bed on one of two Point Prevalence study days in 2015.
Ambient sound was measured for 1 minute using an application downloaded to a personal mobile device. Bedside nurses also recorded the total time and number of awakening for each patient overnight.
The study included 539 participants with sound level recorded using an application downloaded to a personal mobile device from 39 ICUs. Maximum and mean sound levels were 78 dB (SD, 9) and 62 dB (SD, 8), respectively. Maximum sound levels were higher in ICUs with a sleep policy or protocol compared with those without maximum sound levels 81 dB (95% CI, 79-83) versus 77 dB (95% CI, 77-78), mean difference 4 dB (95% CI, 0-2), p < 0.001. There was no significant difference in sound levels regardless of single room occupancy, mechanical ventilation status, or illness severity. Clinical nursing staff in all 39 ICUs were able to record sleep assessment in 15-minute intervals. The median time awake and number of prolonged disruptions were 3 hours (interquartile range, 1-4) and three (interquartile range, 2-5), respectively.
Across a large number of ICUs, patients were exposed to high sound levels and substantial sleep disruption irrespective of factors including previous implementation of a sleep policy. Sound and sleep measurement using simple and accessible tools can facilitate future studies and could feasibly be implemented into clinical practice.
使用临床可用工具来确定一系列具有代表性的重症监护病房（ICU）中与声音水平和睡眠干扰相关的科室层面及个体患者因素。
一项横断面观察性研究。
澳大利亚和新西兰的重症监护病房。
2015年两个点患病率研究日中所有占用ICU床位的16岁及以上患者。
使用下载到个人移动设备的应用程序测量环境声音1分钟。床边护士还记录了每位患者夜间的总觉醒时间和觉醒次数。
该研究纳入了539名参与者，使用从39个ICU下载到个人移动设备的应用程序记录声音水平。最大声音水平和平均声音水平分别为78分贝（标准差，9）和62分贝（标准差，8）。与没有声音水平限制的ICU相比，有睡眠政策或协议的ICU最大声音水平更高，分别为81分贝（95%置信区间，79 - 83）和77分贝（95%置信区间，77 - 78），平均差异为4分贝（95%置信区间，0 - 2），p < 0.001。无论单人病房入住情况、机械通气状态或疾病严重程度如何，声音水平均无显著差异。所有39个ICU的临床护理人员都能够每隔15分钟记录一次睡眠评估情况。觉醒的中位时间和长时间干扰次数分别为3小时（四分位间距，1 - 4）和3次（四分位间距，2 - 5）。
在大量的重症监护病房中，无论包括先前是否实施睡眠政策等因素如何，患者都暴露于高声级和严重的睡眠干扰中。使用简单且可获取的工具进行声音和睡眠测量有助于未来的研究，并且可以切实地应用于临床实践。
