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Sleep during and after critical illness and psychological health in recovery
PAPERS AND POSTER ABSTRACTS / Australian Critical Care 26 (2013) 81–98
Adult Critical Care Free Papers Sleep during and after critical illness and psychological health in recovery S. McKinley 1,2,∗ , M. Fien 3 , R. Elliott 1,2 , D. Elliott 1 1
University of Technology Sydney, Australia 2 Northern Sydney Local Health District, Australia 3 Agency for Clinical Innovation, NSW, Australia
Winner: Best Nursing Presentation sponsored by Mayo Healthcare
Introduction: Intensive care patients often report sleep disruption in ICU and during recovery from critical illness. Objectives: To assess patients’ self-reported sleep quality in ICU, on the hospital ward and 6 months after discharge, whether patients who experience sleep disruption in ICU experience problems sleeping during recovery and whether sleep disruption is associated with psychological recovery. Methods: Patients in ICU for ≥2 nights self-reported on their sleep prehospital (Insomnia Severity Index), in ICU and the ward (Richards Campbell Sleep Questionnaire) and 6 months after hospital discharge (Pittsburgh Sleep Quality Index), and after discharge completed the Intensive Care Experience Questionnaire (ICEQ), the Depression, Anxiety and Stress Scales, the Posttraumatic Stress Checklist (PCL) and SF-36 quality of life. Associations between sleep and outcomes were examined using bivariate and multiple linear regression analyses Results: Patients (n = 222) were aged (mean ± SD) 57.2 ± 17.2 years, 35% female and had APACHE II scores of 25 ± 5, ICU stays of 5 ± 6 days and BMI 26 ± 5. Poor sleep at 6 months was reported by 101 (57%), and by 38 patients (17%) at all timepoints. In multivariate analysis, prehospitalisation insomnia (p = .0005), sleep quality on the ward (p = .006) plus anxiety (p = .002), and mental (p = .0005) and physical health (p = 0005) were associated with sleep disruption in survivors 6 months after ICU treatment. Conclusions: Sleep is a significant issue for over half of survivors 6 months after ICU treatment. Poor sleep at 6 months was associated with prehospital insomnia, sleep quality on the hospital ward and anxiety, physical health and mental health at 6 months.
83
Provision of mechanical ventilation to pregnant/postpartum women with H1N1 influenza: A case–control study W. Pollock 1,∗ , R. Bellomo 2 , S. Webb 3 , I. Seppelt 4 , A. Davies 5 , B. Howe 6 , S. Morrison 6 , E. Sullivan 7 , M. Gerdzt 8 , M. Bailey 6 1
La Trobe University/Mercy Hospital For Women, Australia Austin Health/ANZIC RC/Monash University, Australia 3 Royal Perth Hospital/University of Western Australia, Australia 4 Nepean Hospital/University of Sydney, Australia 5 Alfred Hospital/Monash University, Australia 6 ANZIC RC/Monash University, Australia 7 University of New South Wales, Australia 8 Royal Melbourne Hospital/University of Melbourne, Australia 2
Introduction: During the influenza pandemic of 2009, clinicians delivered mechanical ventilation to pregnant women with little evidence to guide practice. Objective: To compare the provision of mechanical ventilation to pregnant/postpartum women and a non-pregnant matched control group admitted to ICU with H1N1 influenza. Methods: A case–control study was conducted following ethics approval. A case was defined as a ventilated pregnant/postpartum woman, reported to the Australian and New Zealand INFINITE H1N1 09 study from 1 June, 2009 to 31 August, 2009. Controls were ventilated non-pregnant women (15–49 years) reported to the INFINITE H1N1 09 study during the same time frame. Data were entered into SPSS and analysed using non-parametric statistics; two-tailed p < 0.05 was considered significant. Results: We studied 34 index cases and 30 controls. Index cases were more likely to have a single ABG taken prior to intubation (p < .05). Similar reasons were given for the trigger to intubate (high RR, low PaO2 , increased work of breathing) apart from a high PaCO2 which was a trigger in the control group only (p < .05). There were no differences in the pre and post-intubation ABGs apart from a lower PaCO2 (p < .05) and lower HCO3 (p < .05) in cases. Initial ventilator mode, VT, MV and RR demonstrated no differences. Both groups showed increases in PaO2 and PaCO2 , and a decrease in pH from the pre-intubation to post-intubation ABGs (p < .05). Conclusions: There were physiological differences between the two groups with pregnant/postpartum women showing lower PaCO2 and HCO3 . However, initial ventilator support was not significantly different for pregnant/postpartum women compared with controls. Funding acknowledgement: With thanks to the Helen Macpherson Smith Trust. http://dx.doi.org/10.1016/j.aucc.2013.02.009
http://dx.doi.org/10.1016/j.aucc.2013.02.008 Reducing the frequency of aspirating gastric tubes in patients enterally fed in the ICU: A randomised control trial T. Williams 1,∗ , G. Leslie 2 , L. Mills 3 , H. Davies 3 , T. Leen 3 , G. Dobb 4 1
Emergency Medicine, The University of Western Australia (M516) and Royal Perth Hospital, Australia 2 School of Nursing and Midwifery Curtin University, Australia 3 ICU Royal Perth Hospital, Australia 4 ICU Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia, Australia Background: Enteral nutrition (EN) tolerance is monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating gastric tubes.
Adult Critical Care Free Papers Sleep during and after critical illness and psychological health in recovery S. McKinley 1,2,∗ , M. Fien 3 , R. Elliott 1,2 , D. Elliott 1 1
University of Technology Sydney, Australia 2 Northern Sydney Local Health District, Australia 3 Agency for Clinical Innovation, NSW, Australia
Winner: Best Nursing Presentation sponsored by Mayo Healthcare
Introduction: Intensive care patients often report sleep disruption in ICU and during recovery from critical illness. Objectives: To assess patients’ self-reported sleep quality in ICU, on the hospital ward and 6 months after discharge, whether patients who experience sleep disruption in ICU experience problems sleeping during recovery and whether sleep disruption is associated with psychological recovery. Methods: Patients in ICU for ≥2 nights self-reported on their sleep prehospital (Insomnia Severity Index), in ICU and the ward (Richards Campbell Sleep Questionnaire) and 6 months after hospital discharge (Pittsburgh Sleep Quality Index), and after discharge completed the Intensive Care Experience Questionnaire (ICEQ), the Depression, Anxiety and Stress Scales, the Posttraumatic Stress Checklist (PCL) and SF-36 quality of life. Associations between sleep and outcomes were examined using bivariate and multiple linear regression analyses Results: Patients (n = 222) were aged (mean ± SD) 57.2 ± 17.2 years, 35% female and had APACHE II scores of 25 ± 5, ICU stays of 5 ± 6 days and BMI 26 ± 5. Poor sleep at 6 months was reported by 101 (57%), and by 38 patients (17%) at all timepoints. In multivariate analysis, prehospitalisation insomnia (p = .0005), sleep quality on the ward (p = .006) plus anxiety (p = .002), and mental (p = .0005) and physical health (p = 0005) were associated with sleep disruption in survivors 6 months after ICU treatment. Conclusions: Sleep is a significant issue for over half of survivors 6 months after ICU treatment. Poor sleep at 6 months was associated with prehospital insomnia, sleep quality on the hospital ward and anxiety, physical health and mental health at 6 months.
83
Provision of mechanical ventilation to pregnant/postpartum women with H1N1 influenza: A case–control study W. Pollock 1,∗ , R. Bellomo 2 , S. Webb 3 , I. Seppelt 4 , A. Davies 5 , B. Howe 6 , S. Morrison 6 , E. Sullivan 7 , M. Gerdzt 8 , M. Bailey 6 1
La Trobe University/Mercy Hospital For Women, Australia Austin Health/ANZIC RC/Monash University, Australia 3 Royal Perth Hospital/University of Western Australia, Australia 4 Nepean Hospital/University of Sydney, Australia 5 Alfred Hospital/Monash University, Australia 6 ANZIC RC/Monash University, Australia 7 University of New South Wales, Australia 8 Royal Melbourne Hospital/University of Melbourne, Australia 2
Introduction: During the influenza pandemic of 2009, clinicians delivered mechanical ventilation to pregnant women with little evidence to guide practice. Objective: To compare the provision of mechanical ventilation to pregnant/postpartum women and a non-pregnant matched control group admitted to ICU with H1N1 influenza. Methods: A case–control study was conducted following ethics approval. A case was defined as a ventilated pregnant/postpartum woman, reported to the Australian and New Zealand INFINITE H1N1 09 study from 1 June, 2009 to 31 August, 2009. Controls were ventilated non-pregnant women (15–49 years) reported to the INFINITE H1N1 09 study during the same time frame. Data were entered into SPSS and analysed using non-parametric statistics; two-tailed p < 0.05 was considered significant. Results: We studied 34 index cases and 30 controls. Index cases were more likely to have a single ABG taken prior to intubation (p < .05). Similar reasons were given for the trigger to intubate (high RR, low PaO2 , increased work of breathing) apart from a high PaCO2 which was a trigger in the control group only (p < .05). There were no differences in the pre and post-intubation ABGs apart from a lower PaCO2 (p < .05) and lower HCO3 (p < .05) in cases. Initial ventilator mode, VT, MV and RR demonstrated no differences. Both groups showed increases in PaO2 and PaCO2 , and a decrease in pH from the pre-intubation to post-intubation ABGs (p < .05). Conclusions: There were physiological differences between the two groups with pregnant/postpartum women showing lower PaCO2 and HCO3 . However, initial ventilator support was not significantly different for pregnant/postpartum women compared with controls. Funding acknowledgement: With thanks to the Helen Macpherson Smith Trust. http://dx.doi.org/10.1016/j.aucc.2013.02.009
http://dx.doi.org/10.1016/j.aucc.2013.02.008 Reducing the frequency of aspirating gastric tubes in patients enterally fed in the ICU: A randomised control trial T. Williams 1,∗ , G. Leslie 2 , L. Mills 3 , H. Davies 3 , T. Leen 3 , G. Dobb 4 1
Emergency Medicine, The University of Western Australia (M516) and Royal Perth Hospital, Australia 2 School of Nursing and Midwifery Curtin University, Australia 3 ICU Royal Perth Hospital, Australia 4 ICU Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia, Australia Background: Enteral nutrition (EN) tolerance is monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating gastric tubes.