- Email: [email protected]
An Update on Sleep and Sedation Issues in Critical Care
Sedation and Sleep in Critical Care: An Update
Preface An Update on Sleep and Sedation Issues in Critical Care
Jan Foster, PhD, APRN, CNS Editor
More than a decade has passed since the first Critical Care Nursing Clinics of North America issue on sleep and sedation concerns experienced by critically ill patients was published. Much progress has been made in a relatively short time span. One thing that has not changed is the challenge of administering adequate sedation and analgesia during transportation of critically ill patients, both intrahospital and interfacility. Johnston and colleagues propose recommendations for selection, dosing, and timing of administration of sedatives and analgesics to optimize comfort and safety during and immediately following transport. Riggi, Zapantis, and Leung describe tolerance to sedatives, which can lead to excessive dosing, along with the risk for iatrogenic withdrawal. Both phenomena contribute to additional complications of sedative use. Recognition and prevention strategies are offered. Kaplow addresses sleep disturbances and interference with healing mechanisms in the critically ill, with a discussion of physiologic processes disrupted by environmental factors, patient factors, medications, and other aspects of patient management. The pharmacokinetics and pharmacodynamics of sedatives and analgesics used in critical illness are detailed by Yogaratnam and colleagues, with emphasis on tailoring drug regimens for patients with compromised renal and/or hepatic function to prevent adverse events. Blissitt addresses the physiologic consequences of mechanical ventilation on sleep and provides a menu of ventilator modes available to mitigate some of the problems. Standard sedation assessment methods in neuro-injured patients can be counter to management approaches that include minimal stimulation; also sedation can mask decreasing neurologic response patterns. Olson, Phillips, and Graffagnino offer alternative technological methods to augment traditional assessment techniques. Obstructive sleep apnea, often undiagnosed when patients enter the ICU, increases the risk of sedative use. Weatherspoon, Sullivan, and Weatherspoon describe screening tools and guidelines for sedation administration in this patient population. Foster discusses immediate and long-term complications of sedation, using the new Crit Care Nurs Clin N Am 28 (2016) xi–xii http://dx.doi.org/10.1016/j.cnc.2016.03.001 0899-5885/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
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framework, post-ICU syndrome. A major advance over the past decade is the development of the Clinical Practice Guidelines for Pain, Agitation, and Delirium, described by Krupp and Balas in this issue, who bring the Guidelines to life with strategies for clinical application. Acutely ill patients with cancer experience unique sleep disruption patterns due to tumor pathophysiology, treatment modalities, symptomatology, psychosocial alterations, and comorbid medical conditions, explained by Matthews, Tanner, and Dumont. Methods of sleep assessment and interventions to promote sleep are described. We hope that this update on sleep and sedation increases awareness of the potential for problems during critical illness beyond the disease or primary condition necessitating ICU care. The authors for each article have updated a review of the literature and incorporated the most current evidence; it is our intent that critical care professionals find practical application of this state of the science content on sleep and sedation issues for critically ill patients. Jan Foster, PhD, APRN, CNS Nursing Inquiry and Intervention, Inc The Woodlands, TX 77381, USA E-mail address: [email protected]
Preface An Update on Sleep and Sedation Issues in Critical Care
Jan Foster, PhD, APRN, CNS Editor
More than a decade has passed since the first Critical Care Nursing Clinics of North America issue on sleep and sedation concerns experienced by critically ill patients was published. Much progress has been made in a relatively short time span. One thing that has not changed is the challenge of administering adequate sedation and analgesia during transportation of critically ill patients, both intrahospital and interfacility. Johnston and colleagues propose recommendations for selection, dosing, and timing of administration of sedatives and analgesics to optimize comfort and safety during and immediately following transport. Riggi, Zapantis, and Leung describe tolerance to sedatives, which can lead to excessive dosing, along with the risk for iatrogenic withdrawal. Both phenomena contribute to additional complications of sedative use. Recognition and prevention strategies are offered. Kaplow addresses sleep disturbances and interference with healing mechanisms in the critically ill, with a discussion of physiologic processes disrupted by environmental factors, patient factors, medications, and other aspects of patient management. The pharmacokinetics and pharmacodynamics of sedatives and analgesics used in critical illness are detailed by Yogaratnam and colleagues, with emphasis on tailoring drug regimens for patients with compromised renal and/or hepatic function to prevent adverse events. Blissitt addresses the physiologic consequences of mechanical ventilation on sleep and provides a menu of ventilator modes available to mitigate some of the problems. Standard sedation assessment methods in neuro-injured patients can be counter to management approaches that include minimal stimulation; also sedation can mask decreasing neurologic response patterns. Olson, Phillips, and Graffagnino offer alternative technological methods to augment traditional assessment techniques. Obstructive sleep apnea, often undiagnosed when patients enter the ICU, increases the risk of sedative use. Weatherspoon, Sullivan, and Weatherspoon describe screening tools and guidelines for sedation administration in this patient population. Foster discusses immediate and long-term complications of sedation, using the new Crit Care Nurs Clin N Am 28 (2016) xi–xii http://dx.doi.org/10.1016/j.cnc.2016.03.001 0899-5885/16/$ – see front matter Ó 2016 Published by Elsevier Inc.
ccnursing.theclinics.com
xii
Preface
framework, post-ICU syndrome. A major advance over the past decade is the development of the Clinical Practice Guidelines for Pain, Agitation, and Delirium, described by Krupp and Balas in this issue, who bring the Guidelines to life with strategies for clinical application. Acutely ill patients with cancer experience unique sleep disruption patterns due to tumor pathophysiology, treatment modalities, symptomatology, psychosocial alterations, and comorbid medical conditions, explained by Matthews, Tanner, and Dumont. Methods of sleep assessment and interventions to promote sleep are described. We hope that this update on sleep and sedation increases awareness of the potential for problems during critical illness beyond the disease or primary condition necessitating ICU care. The authors for each article have updated a review of the literature and incorporated the most current evidence; it is our intent that critical care professionals find practical application of this state of the science content on sleep and sedation issues for critically ill patients. Jan Foster, PhD, APRN, CNS Nursing Inquiry and Intervention, Inc The Woodlands, TX 77381, USA E-mail address: [email protected]