Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT; Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT.
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT.
Chest. 2021 Sep;160(3):899-908. doi: 10.1016/j.chest.2021.03.030. Epub 2021 Mar 24.
Delirium is a deleterious condition affecting up to 60% of patients in the surgical ICU (SICU). Few SICU-focused delirium interventions have been implemented, including those addressing sleep-wake disruption, a modifiable delirium risk factor common in critically ill patients.
What is the effect on delirium and sleep quality of a multicomponent nonpharmacologic intervention aimed at improving sleep-wake disruption in patients in the SICU setting?
Using a staggered pre-post design, we implemented a quality improvement intervention in two SICUs (general surgery or trauma and cardiovascular) in an academic medical center. After a preintervention (baseline) period, a multicomponent unit-wide nighttime (ie, efforts to minimize unnecessary sound and light, provision of earplugs and eye masks) and daytime (ie, raising blinds, promotion of physical activity) intervention bundle was implemented. A daily checklist was used to prompt staff to complete intervention bundle elements. Delirium was evaluated twice daily using the Confusion Assessment Method for the Intensive Care Unit. Patient sleep quality ratings were evaluated daily using the Richards-Campbell Sleep Questionnaire (RCSQ).
Six hundred forty-six SICU admissions (332 baseline, 314 intervention) were analyzed. Median age was 61 years (interquartile range, 49-70 years); 35% of the cohort were women and 83% were White. During the intervention period, patients experienced fewer days of delirium (proportion ± SD of ICU days, 15 ± 27%) as compared with the preintervention period (20 ± 31%; P = .022), with an adjusted pre-post decrease of 4.9% (95% CI, 0.5%-9.2%; P = .03). Overall RCSQ-perceived sleep quality ratings did not change, but the RCSQ noise subscore increased (9.5% [95% CI, 1.1%-17.5%; P = .02).
Our multicomponent intervention was associated with a significant reduction in the proportion of days patients experienced delirium, reinforcing the feasibility and effectiveness of a nonpharmacologic sleep-wake bundle to reduce delirium in critically ill patients in the SICU.
ClinicalTrials.gov; No.: NCT03313115; URL: www.clinicaltrials.gov.
谵妄是一种有害的疾病，影响多达 60%的外科重症监护病房（SICU）患者。很少有针对 SICU 中谵妄的干预措施，包括针对睡眠-觉醒障碍的干预措施，这是一种常见于重症患者的可改变的谵妄危险因素。
旨在改善 SICU 环境中患者睡眠-觉醒障碍的多组分非药物干预措施对谵妄和睡眠质量的影响是什么？
我们使用交错式前后设计，在学术医疗中心的两个 SICU（普通外科或创伤和心血管）中实施了一项质量改进干预措施。在预干预（基线）期之后，实施了多组分单元范围的夜间（即，尽量减少不必要的声音和光线，提供耳塞和眼罩）和日间（即，提高百叶窗，促进身体活动）干预包。使用每日清单提示工作人员完成干预包元素。使用重症监护病房谵妄评估方法（CAM-ICU）每天两次评估谵妄。使用 Richards-Campbell 睡眠问卷（RCSQ）每天评估患者的睡眠质量评分。
共分析了 646 例 SICU 入院患者（332 例基线，314 例干预）。中位年龄为 61 岁（四分位距，49-70 岁）；队列中有 35%的女性和 83%的白人。与干预前相比，在干预期间患者经历的谵妄天数更少（ICU 天数的比例±SD，15%±27% vs 20%±31%；P=0.022），调整前后的下降幅度为 4.9%（95%CI，0.5%-9.2%；P=0.03）。总体 RCSQ 感知睡眠质量评分没有变化，但 RCSQ 噪音子评分增加（9.5%[95%CI，1.1%-17.5%；P=0.02]）。
我们的多组分干预措施与患者经历谵妄的天数比例显著降低相关，这加强了非药物睡眠-觉醒包在减少 SICU 中重症患者谵妄方面的可行性和有效性。
ClinicalTrials.gov；编号：NCT03313115；网址：www.clinicaltrials.gov。
