It can be difficult to get a good night’s sleep in a hospital, especially in a noisy intensive care unit. This is a cause for concern as research has shown that insomnia may lead to delirium — sudden severe confusion and rapid brain changes that could delay recovery and lead to short and long-term cognitive problems.
A research team at the Johns Hopkins Hospital carried out a project to see if they could reduce delirium by taking steps to reduce nighttime noise, light and staff interruptions and to cut back on offering certain medications for insomnia.
“With our interventions, we were able to improve a patient’s odds of being free of delirium in the ICU by 54 percent, even after taking into account the diagnosis, need for mechanical ventilation, age and other factors,” said Biren Kamdar, M.D., M.B.A, M.H.S., a Johns Hopkins pulmonary and critical care fellow who led the initiative.
“In addition, many patients said that the ICU was quiet and comfortable enough for them to get a good night’s sleep,” he said.
Interventions were introduced in stages. The first stage was a 10-item environmental checklist that included turning off televisions, room and hallway lights, safely lowering the number of staff visits to patient rooms overnight, reducing overhead pages and minimizing unnecessary alarms.
In the second stage, patients were offered eye masks, ear plugs and tranquil music. In the final stage, a new medication guideline was put into place that discouraged giving patients certain commonly prescribed drugs for sleep, such as benzodiazepines, that are known to cause delirium.
Before any of the interventions were implemented, the researchers evaluated 122 patients in the intensive care unit for more than eight weeks. After all of the measures were in place, another 178 patients were evaluated.
“Each patient was evaluated twice a day for delirium using the Confusion Assessment Method for the ICU (CAM-ICU), a widely used delirium screening tool. After 13 weeks, during which all of the interventions had been in place, we saw a substantial reduction in patient delirium compared to the baseline group,” said Kamdar.
The researchers measured each patient’s perception of sleep quality with a questionnaire every morning. Although there were positive results from that measure, the improvement was not statistically significant.
“This is a unique study in terms of the number of patients involved and the three stages of interventions,” said Dale M.Needham, M.D., Ph.D., associate professor of pulmonary and critical care medicine at Johns Hopkins and the senior author of the study article.
“Delirium is a syndrome of confused thinking and lack of attention. It typically comes on quickly with illness, and it’s a marker for the health of the brain,” Needham said. “We put together a common-sense approach to change how care is provided to see if by improving sleep, we could reduce patients’ confused thinking, and it was effective.”
Needham noted that physical rehabilitation is vital for the recovery of intensive care patients. If they’re sleepy or delirious, they can’t appropriately participate in this therapy.
“Up to 80 percent of ICU patients may experience delirium during their stay. The longer they have it, the higher their risk of long-lasting problems with memory and other cognitive functions. With advances in medicine and technology, many ICU patients can now recover and go home, so reducing their risk of delirium in the hospital is very important,” said Needham.
Source: Johns Hopkins