The Ohio State University Center for Clinical and Translational Science, 236A Newton Hall, 333 W. 10th Ave., Columbus, OH, 43210, USA.
The Ohio State University College of Nursing, 360 Newton Hall, 1585 Neil Avenue, Columbus OH 43210, USA.
Heart Lung. 2023 Nov-Dec;62:215-224. doi: 10.1016/j.hrtlng.2023.08.005. Epub 2023 Aug 15.
Sleep disruption is frequently observed in children with delirium in the pediatric intensive care unit (PICU).
This observational pilot study explores relationships among modifiable characteristics of the PICU environment (i.e., light, sound, clinician caregiving patterns), sleep disruption, and delirium.
Ten children, 1 to 4 years old, were recruited within 48 h of PICU admission and followed until discharge. A light meter, dosimeter, and video camera were placed at bedside to measure PICU environmental exposures. Sleep was measured via actigraphy. Twice daily delirium screening was conducted. Descriptive statistics were used to describe the PICU environment, sleep, and delirium experienced by children. Bivariate analyses were performed to determine relationships among variables.
Average participant age was 21 (SD = 9.6) months. Eight (80%) were admitted for respiratory failure. Median PICU length of stay was 36.7 (IQR[29.6, 51.5]) hours, which limited data collection duration. Delirium prevalence was 60% (n = 6). Children experienced low daytime light levels (x¯ = 112.8 lux, SD = 145.5) and frequent peaks (x¯ = 1.9/hr, SD = 0.5) of excessive sound (i.e., ≥ 45 A-weighted decibels). Clinician caregiving episodes were frequent (x¯ = 4.5/hr, SD = 2.6). Children experienced 7.3 (SD = 2.1) awakenings per hour of sleep and a median sleep episode duration of 1.4 (IQR[0.6, 2.3]) hours. On average, children with delirium experienced 1.1 more awakenings per sleep hour and 42 fewer minutes of sleep per sleep episode during the night shift. Increased clinician care frequency and duration were associated with worse sleep quality and delirium.
Study results will inform future, large-scale research and nurse-driven sleep promotion interventions.
在儿科重症监护病房（PICU）中，患有谵妄的儿童经常出现睡眠中断。
本观察性初步研究探讨了 PICU 环境的可调节特征（即光线、声音、临床医护模式）、睡眠中断和谵妄之间的关系。
在 PICU 入院后 48 小时内招募了 10 名 1 至 4 岁的儿童，并在出院前进行随访。床边放置了一个光度计、剂量计和摄像机，以测量 PICU 环境暴露情况。通过活动记录仪测量睡眠。每天两次进行谵妄筛查。使用描述性统计来描述儿童的 PICU 环境、睡眠和谵妄经历。进行了双变量分析以确定变量之间的关系。
参与者的平均年龄为 21 （SD=9.6）个月。8 名（80%）因呼吸衰竭而入院。PICU 住院时间中位数为 36.7（IQR[29.6, 51.5]）小时，这限制了数据收集的持续时间。谵妄的患病率为 60%（n=6）。儿童的日间光照水平较低（x¯=112.8lux，SD=145.5），并且频繁出现（x¯=1.9/hr，SD=0.5）过度声音（即≥45 加权分贝）的高峰。临床医护 episode 频繁（x¯=4.5/hr，SD=2.6）。儿童每小时睡眠中平均有 7.3（SD=2.1）次觉醒，每睡眠 episode 中平均有 1.4（IQR[0.6, 2.3]）小时的睡眠。平均而言，患有谵妄的儿童在夜间班次每小时睡眠中经历 1.1 次更多的觉醒，并且夜间班次中每睡眠 episode 少 42 分钟的睡眠。临床医护 episode 频率和持续时间的增加与睡眠质量和谵妄的恶化有关。
研究结果将为未来的大规模研究和以护士为驱动的睡眠促进干预措施提供信息。
