University of North Carolina Medical Center, Chapel Hill, NC, USA.
University of North Carolina, Chapel Hill, NC, USA.
Ann Pharmacother. 2022 Jun;56(6):645-655. doi: 10.1177/10600280211043278. Epub 2021 Sep 7.
Evidence suggests that poor sleep increases risk of delirium. Because delirium is associated with poor outcomes, institutions have developed protocols to improve sleep in critically ill patients.
To assess the impact of implementing a multicomponent sleep protocol.
In this prospective, preimplementation and postimplementation evaluation, adult patients admitted to the medical intensive care unit (ICU) over 42 days were included. Outcomes evaluated included median delirium-free days, median Richards-Campbell Sleep Questionnaire (RCSQ) score, median optimal sleep nights, duration of mechanical ventilation (MV), ICU and hospital length of stay (LOS), and in-hospital mortality.
The preimplementation group included 78 patients and postimplementation group, 84 patients. There was no difference in median delirium-free days (1 day [interquartile range, IQR, = 0-2.5] vs 1 day [IQR = 0-2]; = 0.48), median RCSQ score (59.4 [IQR = 43.2-71.6] vs 61.2 [IQR = 49.9-75.5]; = 0.20), median optimal sleep nights (1 night [IQR = 0-2] vs 1 night [IQR = 0-2]; = 0.95), and in-hospital mortality (16.7% vs 17.9%, = 1.00). Duration of MV (8 days [IQR = 4-10] vs 4 days [IQR = 2-7]; = 0.03) and hospital LOS (13 days [IQR = 7-22.3] vs 8 days [IQR = 6-17]; = 0.05) were shorter in the postimplementation group, but both were similar between groups after adjusting for age and severity of illness.
This report demonstrates that implementation of a multicomponent sleep protocol in everyday ICU care is feasible, but limitations exist when evaluating impact on measurable outcomes. Additional evaluations are needed to identify the most meaningful interventions and best practices for quantifying impact on patient outcomes.
有证据表明，睡眠质量差会增加谵妄的风险。由于谵妄与不良预后有关，因此各医疗机构制定了改善危重症患者睡眠的方案。
评估实施多组分睡眠方案的效果。
在这项前瞻性的、实施前和实施后的评估中，纳入了在 42 天内入住内科重症监护病房（ICU）的成年患者。评估的结果包括无谵妄天数的中位数、Richards-Campbell 睡眠问卷（RCSQ）评分的中位数、最佳睡眠时间的中位数、机械通气（MV）时间、ICU 和住院时间的中位数以及院内死亡率。
实施前组包括 78 例患者，实施后组包括 84 例患者。无谵妄天数的中位数（1 天 [四分位距，IQR = 0-2.5] 与 1 天 [IQR = 0-2]； = 0.48）、RCSQ 评分的中位数（59.4 [IQR = 43.2-71.6] 与 61.2 [IQR = 49.9-75.5]； = 0.20）、最佳睡眠时间的中位数（1 晚 [IQR = 0-2] 与 1 晚 [IQR = 0-2]； = 0.95）和院内死亡率（16.7% 与 17.9%； = 1.00）无显著差异。实施后组 MV 时间（8 天 [IQR = 4-10] 与 4 天 [IQR = 2-7]； = 0.03）和住院时间（13 天 [IQR = 7-22.3] 与 8 天 [IQR = 6-17]； = 0.05）更短，但调整年龄和疾病严重程度后，两组间无显著差异。
本报告表明，在日常 ICU 护理中实施多组分睡眠方案是可行的，但在评估对可测量结果的影响时存在局限性。需要进一步评估，以确定对患者结局有意义的干预措施和最佳实践，从而量化对患者结局的影响。
