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Intensive care patients reports that their sleep is poor
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Papers and Poster Abstracts
Acute respiratory management of tetraplegia in ICU: A retrospective medical chart review
Intensive care patients reports that their sleep is poor
B. Wadsworth 1 , E. Iliff 1 , C. Hackett 1,∗ , P. Kruger 2
S. McKinley 1,2,∗ , R. Elliott 1,2 , D. Elliott 1 , M. Fien 1
1 Physiotherapy
Department, Princess Alexandra Hospital, Australia 2 Intensive Care Unit, Princess Alexandra Hospital, Australia Recent literature has supported the use of clinical pathways in acute airway management of tetrapelgic patients to enhance outcomes. A retrospective review was conducted of patients admitted (2006—2009) to the Intensive Care Unit (ICU) within forty-eight hours of injury, with complete neurology at T1 and above to determine current management. Medical charts were reviewed for demographics, cause of injury, neurological and respiratory assessments, spinal surgery, intubation, extubation and tracheostomy incidence. Three Physiotherapists completed the review with a consulting Intensive Care specialist. Thirty-one patients were included. The mean age was 35 years with 94% of patients being male. Neurological classification of C4 and above accounted for 61% of patients with 39% ranging C5-T1. Of those requiring spinal surgery, 74% had surgery within 48 h of injury. Intubation occurred in 93% of patients at a mean of 12 h post injury. Mean intubation length was three days, 36% failing one extubation requiring reintubation, on average 32 h later. Mean physiotherapy interventions 24 h prior to successful extubation was 2.6 compared to 4.15 per day for the first three days post. Eight patients required a tracheostomy, which was performed between 8 and 13 days from injury. The ICU mean length of stay was 25 days for tracheostomy patients compared to 7 days for patients successfully extubated. This retrospective review highlights the incidence of ventilatory insufficiency and need for intensive management of respiratory function in people with tetraplegia. Further research is required to better define optimal airway management and approaches to weaning ventilation from these patients. Funding: Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital. doi:10.1016/j.aucc.2011.12.012
1 University 2 Northern
of Technology Sydney, Australia Sydney Local Health District, Australia
In the last three decades many studies have shown that sleep is poor in intensive care patients using objective and subjective measures, but most have had small sample sizes. The objectives of this study were to obtain self-reports of patients’ sleep in ICU and after discharge from ICU, and of perceived sources of disruption to sleep in ICU. Patients cleared for transfer from ICU who were able to give informed consent (n = 222) completed selfreports of their sleep using the Richards—Campbell Sleep Questionnaire (RCSQ) (5 mm × 100 mm VAS) and the 10-point Sleep in Intensive Care Questionnaire (SICQ). Patients (n = 185) also completed the Intensive Care Experience Questionnaire (ICEQ) two months after leaving hospital. Patients were aged 57.2 ± 17.2 years, were 35% female, had admission APACHE II scores of 24.7 ± 5.3 and a median ICU stay of 3 days. The average RCSQ score was 47.18 ± 28.1 in ICU and 54.33 ± 24.4 in the ward. Scores < 50 on the RCSQ were reported by 48.2% of patients in ICU, 52.3% in the ward and by 27.9% in both ICU and the ward. Patients rated their sleep in ICU as 4.24 ± 2.3 versus 7.37 ± 2.1 before hospitalisation (t = 13.39, p < .001). The main disruption to sleep in ICU was noise: 5.81/10. On the ICEQ 67.0% reported that they had bad dreams and 67.6% that they saw strange things all or most of the time, and 35.6% that they were constantly disturbed. Conclusion: many patients experience sleep disruption in ICU, attributed primarily to noise, and sleep disruption persisted after leaving ICU for a substantial proportion of patients. doi:10.1016/j.aucc.2011.12.013
Papers and Poster Abstracts
Acute respiratory management of tetraplegia in ICU: A retrospective medical chart review
Intensive care patients reports that their sleep is poor
B. Wadsworth 1 , E. Iliff 1 , C. Hackett 1,∗ , P. Kruger 2
S. McKinley 1,2,∗ , R. Elliott 1,2 , D. Elliott 1 , M. Fien 1
1 Physiotherapy
Department, Princess Alexandra Hospital, Australia 2 Intensive Care Unit, Princess Alexandra Hospital, Australia Recent literature has supported the use of clinical pathways in acute airway management of tetrapelgic patients to enhance outcomes. A retrospective review was conducted of patients admitted (2006—2009) to the Intensive Care Unit (ICU) within forty-eight hours of injury, with complete neurology at T1 and above to determine current management. Medical charts were reviewed for demographics, cause of injury, neurological and respiratory assessments, spinal surgery, intubation, extubation and tracheostomy incidence. Three Physiotherapists completed the review with a consulting Intensive Care specialist. Thirty-one patients were included. The mean age was 35 years with 94% of patients being male. Neurological classification of C4 and above accounted for 61% of patients with 39% ranging C5-T1. Of those requiring spinal surgery, 74% had surgery within 48 h of injury. Intubation occurred in 93% of patients at a mean of 12 h post injury. Mean intubation length was three days, 36% failing one extubation requiring reintubation, on average 32 h later. Mean physiotherapy interventions 24 h prior to successful extubation was 2.6 compared to 4.15 per day for the first three days post. Eight patients required a tracheostomy, which was performed between 8 and 13 days from injury. The ICU mean length of stay was 25 days for tracheostomy patients compared to 7 days for patients successfully extubated. This retrospective review highlights the incidence of ventilatory insufficiency and need for intensive management of respiratory function in people with tetraplegia. Further research is required to better define optimal airway management and approaches to weaning ventilation from these patients. Funding: Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital. doi:10.1016/j.aucc.2011.12.012
1 University 2 Northern
of Technology Sydney, Australia Sydney Local Health District, Australia
In the last three decades many studies have shown that sleep is poor in intensive care patients using objective and subjective measures, but most have had small sample sizes. The objectives of this study were to obtain self-reports of patients’ sleep in ICU and after discharge from ICU, and of perceived sources of disruption to sleep in ICU. Patients cleared for transfer from ICU who were able to give informed consent (n = 222) completed selfreports of their sleep using the Richards—Campbell Sleep Questionnaire (RCSQ) (5 mm × 100 mm VAS) and the 10-point Sleep in Intensive Care Questionnaire (SICQ). Patients (n = 185) also completed the Intensive Care Experience Questionnaire (ICEQ) two months after leaving hospital. Patients were aged 57.2 ± 17.2 years, were 35% female, had admission APACHE II scores of 24.7 ± 5.3 and a median ICU stay of 3 days. The average RCSQ score was 47.18 ± 28.1 in ICU and 54.33 ± 24.4 in the ward. Scores < 50 on the RCSQ were reported by 48.2% of patients in ICU, 52.3% in the ward and by 27.9% in both ICU and the ward. Patients rated their sleep in ICU as 4.24 ± 2.3 versus 7.37 ± 2.1 before hospitalisation (t = 13.39, p < .001). The main disruption to sleep in ICU was noise: 5.81/10. On the ICEQ 67.0% reported that they had bad dreams and 67.6% that they saw strange things all or most of the time, and 35.6% that they were constantly disturbed. Conclusion: many patients experience sleep disruption in ICU, attributed primarily to noise, and sleep disruption persisted after leaving ICU for a substantial proportion of patients. doi:10.1016/j.aucc.2011.12.013