SLEEP ENHANCEMENT PROGRAMS IN THE SURGICAL ICU : A PILOT CLINICAL TRIAL

picture of John Santoro Jr. presenting his/her poster: SLEEP ENHANCEMENT PROGRAMS IN THE SURGICAL ICU : A PILOT CLINICAL TRIAL

John Santoro Jr. , Irada Ibrahim-zada MD PhD, George D. Sirakis BS, Randall S. Friese MD FACS*

SLEEP ENHANCEMENT PROGRAMS IN THE SURGICAL ICU : A PILOT CLINICAL TRIAL

Introduction:  Sleep deprivation, common in intensive care unit (ICU) patients, has been associated with increased morbidity and/or mortality. Routine patient care in the ICU exposes patients to significant numbers of audible and visual disturbances that may be associated with sleep interruptions. Current ICU care protocols do not try to minimize sleep interruptions.

Aims: The aim of the study was to determine whether utilization of a nocturnal Sleep Enhancement Program (SEP) in the surgical ICU would reduce the number of audible and visual sleep interruptions, and increase patient sleep time.

Methods: We performed a prospective cohort study examining the effect of a SEP on patients cared for in the surgical intensive care unit (SICU) at our academic medical center (UAMC). ICU nurses and staff were educated about the benefits of sleep promotion and the detriments of sleep deprivation and trained to implement the SEP protocol.  Thirteen patients enrolled in a pilot study were monitored between 2200 and 0600 hours by polysomnography [PSG] audiovisual recording.  Patients that received SEP care (experimental group) were compared to patients without SEP care (control group).  In-room and ambient noises were categorized as 'Environmental Interruptions', while nursing and staff bedside interactions with patients were defined as 'Bedside Interruptions.' Data in both groups was analyzed by two-tail independent t-tests, with the significance p<0.05 on SPSS®.

Results: Only five patients had complete audiovisual and PSG recordings and were included in this pilot study.  There was no difference in overall interruptions between  groups (364.50 vs. 178.67, p=0.099). In-depth analysis of interruptions by type (environmental/bedside) showed a statistically significant decrease in the number of environmental, in-room noises between the control and experimental groups (61.50 vs. 13.00, p=0.012). We also observed a trend in decreased bedside interventions in the experimental group (58.50 vs. 19.33, p=0.066).

Conclusions Excessive environmental noises and bedside interactions between the hours of 2200-0600 may potentially interrupt patient sleep time in the surgical ICU.  The implementation of an evidence-based sleep enhancement program may significantly reduce these interruptions and increase patient’s sleep time. Further studies exploring sleep enhancement programs and their effect on quality of sleep in ICUs are warranted.

This work supported by a grant from  the Arizona Biomedical Research Commission (ABRC) ID #9-022 (RSF)

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