Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Anesthesiology, University of California - Irvine, Orange, CA.
Crit Care Med. 2021 Sep 1;49(9):e822-e832. doi: 10.1097/CCM.0000000000005031.
Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings.
Prospective randomized controlled trial.
Surgical ICU within the University of Texas Southwestern Medical Center.
Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019.
Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care.
The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group's average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8-53.8), the intervention group's average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3-70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores.
These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.
睡眠障碍可能导致谵妄、ICU 住院时间延长和死亡率增加。耳塞和眼罩促进 ICU 患者睡眠的有效性存在相互矛盾的数据。本研究评估了耳塞和眼罩对接受乳房游离皮瓣手术后有频繁觉醒风险的术后外科 ICU 患者睡眠质量的影响。
前瞻性随机对照试验。
德克萨斯大学西南医学中心的外科 ICU。
2018 年 2 月至 2019 年 10 月期间接受乳房游离皮瓣手术后需要每小时进行术后评估而入住外科 ICU 的成年女性患者。
患者被随机分为干预组或对照组。干预组除接受标准术后护理外，还接受耳塞和眼罩，而对照组仅接受标准术后护理。
主要结局是通过 Richards-Campbell 睡眠问卷评估的整体睡眠质量。使用 ICU 家庭满意度的改良版和 ICU 意识模糊评估法评估患者满意度和 ICU 谵妄发生率这两个次要结局。在进行了计划中的中期分析后，由于达到了预设的显著性标准，研究提前终止。与对照组的 Richards-Campbell 睡眠问卷总分 47.3（95%置信区间，40.8-53.8）相比，干预组的 Richards-Campbell 睡眠问卷总分显著更高，为 64.5（95%置信区间，58.3-70.7；p=0.0007）。两组之间的 ICU 意识模糊评估法评分或改良的 ICU 家庭满意度调查评分无显著差异。
这些结果表明，耳塞和眼罩可有效改善接受频繁评估的 ICU 患者的睡眠质量。这些结果为 ICU 中使用非药物促进睡眠的辅助手段提供了更强有力的证据。
