Critically Ill Patient, Intensive Care Unit, Sleep Quality
Conditions
Brief summary
Sleep of critically ill patients is highly disturbed with a high sleep fragmentation; patients spend most of their sleep in very short sleep episodes, lasting less than 10 minutes. Causes of theses sleep alterations are complex including environmental noise (alarms, beepers, conversations…), continuous light, nurse care and repetitive measures of vital parameters. Numerous studies have reported a relationship between severe sleep alterations and a prolonged weaning period and mortality. Improving sleep quality in critically ill patients is a major challenge to promote ICU patient's recovery. A very promising treatment is the application of a nocturnal quiet-time during which non urgent care, comfort care, systematic measures of vital parameters are delayed and clustered in order to limit room entries. However, quiet time procedures have failed to improve sleep quality to date. A miniaturized medical device recording one EEG channel and embedding an automated sleep scoring algorithm running in real-time was devised. This device (positioned on forehead, and continuously recording noise and light levels) indicates if the patient is awake or asleep using a tablet positioned at doorstep of the room, so that nurses know if patient is sleeping, without entering the room. Hypothesis proposes that applying sleep protection procedures (clustering cares, limiting room entries, reducing lights and noise, delaying non urgent care…) when patients are sleeping (= EEG-guided strategies) will increase patients sleep quality. This study will assess the effect of such device on sleep quality in ICU patients. This is a before / after design. The first group (control group), will be recorded but the sleep scoring will not be displayed by the tablet and patient will be expose to standard care. Then, procedure will be established collegially with nurses, nurses assistants and doctors. Then, the second group (treated group) will be recorded with the device displaying the status of the patient (asleep/awake) and all caregivers will be asked to follow the established rules (EEG-guided sleep protection rules)
Interventions
DEVICEEEG-guided sleep protection
The tablet will display a specific picture prioritize sleep or prioritize care depending on the patient status determined by the algorithm. When the picture favor/prioritize sleep is displayed, all caregivers and visiting family are asked to follow the sleep protection rules: refrain to enter the room for not urgent reasons, switch off television, reduced light in the room/corridor, reduce noise in front of the door, close curtain (if any), and delay non urgent care…etc; if caregivers have to enter the room, headlight and/or additional light will be favored. All these rules will be established collegially by nurses and doctors. Obviously, urgent care and reactions to alarms are maintained. When the picture favor/prioritize care is displayed, all caregivers and visiting family are invited to perform non urgent care, cleaning, restocking perfusion needles, comfort care, visiting.
OTHERControl condition
the recording device will be placed on the patient to record sleep but the tablet will be masked and placed face down on the bench in the room, invisible from the door.
Sponsors
Poitiers University Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults admitted in medical ICU of University Hospital of Poitiers * Un-sedated patients displaying a RASS scale between -2 and +1 * Intubated or spontaneously breathing patients * Patient or family have signed the inform consent
Exclusion criteria
* Patients with a central nervous system disease altering sleep scoring * Patients who received drugs (\<24h) modifying significantly EEG and sleep scoring * Patients with cutaneous erosion of the scalp
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sleep quality | Day 1 to Day 4 | Proportion of continuous sleep |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sleep fragmentation | Day 1 to Day 4 | Number of awakenings and micro-awakenings per hour of sleep |
| Environmental noise and environmental light | Day 1 to Day 4 | Number of peak noise end time spent above 20 lux |
| Sleep interruptions by caregivers | Day 1 to Day 4 | Number of room entries while patient is asleep |
| Sleep quality | Day 2 to Day 4 | Proportion of continuous sleep |
| Patient Agitation | Day 1 to day 4 | Number of patients with diminishing (-1 point) Richmond Agitation-Sedation Scale (RASS) score. 10 Agitation-Sedation scale items From +4 (combative) to -5 (non-recoverable) |
| Performance of the algorithm | Day 1 to Day 4 | Number of sleep episodes lasting more than 10 min correctly identified by algorithm (versus vision scoring) |
| Workload assessed by nurses | Day 1 to Day 4 | Score at specific scale assessing workload. From 1- no workload to 10- significant additional workload. |
| Anxiety level | Day 1 to day 4 | Score at Spielberger Y-A scale.It consist of 12 questions, each rated on a scale with 4 response options. Lower score means a minimal anxiety level. |
| Respiratory status | At Unit care discharge, an average of 14 days | Weaning duration (number of days), ventilator free days and respiratory status at discharge |
| Presence of delirium | Day 1 to Day 4 | Number of days with positive Confusion Assessment Method(CAM)-ICU scale. It is made up of 4 criteria. The test is POSITIVE (confusion present) if 1 and 2 + 3 or 4 are met. |
| Unit Care length of stay | At Unit care discharge, an average of 14 days | Number of days in ICU |
| Safety of the procedure | One day after Unit Care discharge, an average of 15 days | Numbers of Serious adverse events and Material defect events |
| Sleep continuity | Day 1 to Day 4 | Part of sleep time past in more than 10 minutes episodes |
| Patient reported sleep quality | Day 1 to day 4 | Score et richards-Campbell sleep questionnaire. It consist of 6 questions, each question scored from 0 to 100. Higher score mean the better sleep |
Countries
France
Outcome results
None listed