Sleep-wake intervention helps manage ICU delirium

The multicomponent sleep-wake intervention bundle significantly decreases the time spent in delirium for critically ill patients, according to a study.

In the study, researchers implemented a quality improvement intervention in surgical intensive care unit (SICUs; general surgery/trauma and cardiovascular) in an academic medical centre using a staggered pre-post design.

The intervention consisted of a baseline period and a multicomponent unit-wide night-time (ie, efforts to limit exposure to unnecessary sound and light, provision of earplugs and eye masks) and daytime (ie, raising blinds, promotion of physical activity) bundle. The staff used a daily checklist to monitor the completion of bundle elements.

Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit twice daily. Patient sleep quality ratings were also measured daily using the Richards-Campbell Sleep Questionnaire (RCSQ).

The analysis included 646 SICU admissions (332 baseline, 314 intervention) in total. The population had a median age of 61 years, 35 percent of them were women, and 83 percent were White.

Results showed that the intervention resulted in fewer days of delirium relative to baseline (proportion of intensive care unit days, 15 percent vs 20 percent; p=0.022), with an adjusted pre-post decrease of 4.9 percent (95 percent confidence interval [CI], 0.5–9.2; p=0.03).

Overall RCSQ perceived sleep quality ratings remained the same, although the RCSQ noise subscore increased by 9.5 percent (95 percent CI, 1.1–17.5; p=0.02) during the intervention.

The findings reinforce the feasibility and effectiveness of a nonpharmacological sleep-wake bundle to reduce delirium in the SICU.