[Health-related quality of life after mechanical ventilation in the intensive care unit]

Prevalence, Risk Factors, and Intervention of Long-Term Sleep Disturbance After Intensive Care Unit Discharge: A Scoping Review

Sleep disturbance in the intensive care unit (ICU) is common and often persistent after discharge. Sleep disturbance after ICU discharge, often classified under post-intensive care syndrome (PICS), affects health-related quality of life (HRQOL). The aim of the current review was to map long-term sleep disturbance after ICU discharge, explore related factors, and suggest prevention and treatment measures, including those related to PICS. We searched the PubMed, CINAHL, and CENTRAL databases until June 12, 2024, using keywords related to ICU, sleep disturbance, and recovery. Inclusion criteria were the inclusion of adult patients, analysis of sleep disturbance after ICU, and evaluation of risk factors or interventions. Reviews, case reports, and non-original studies were excluded. A total of 1,786 studies on sleep disturbance after ICU discharge were initially identified, with 52 studies ultimately included after screening. Prevalence of sleep disturbance after ICU discharge was calculated from 42 studies, with rates of 55.0% at less than one month, 49.6% at 1-3 months, 39.2% at 4-6 months, 23.2% at 7-12 months, and 15.0% over one year. Risk factors for sleep disturbance included older age, female sex, pre-hospital sleep disturbance, ICU and hospital lengths of stay, duration of mechanical ventilation, duration of sedation or analgesia, pain, delirium, and poor sleep quality during hospital ward. Long-term sleep disturbance was associated with PICS. Sleep disturbance was associated with physical disability, cognitive impairment, mental dysfunction (especially depression, post-traumatic stress disorder, and anxiety), and HRQOL, assessed at 4-6 months after hospitalization. Two randomized controlled trials (RCTs) examined interventions for sleep disturbance. Psychological counseling and a 12-month nurse-led collaborative care intervention were found effective in improving long-term sleep disturbance. On the other hand, the use of sleep aids such as earplugs and eye masks in the ICU had no such effect. Sleep disturbance after ICU discharge is common, with over half of the patients being affected within one month, and a link to PICS symptoms exists, highlighting the need for further research on comprehensive interventions.

Non-sedation-Does it improve health-related quality of life after critical illness? A 3-month follow-up sub-study of the NONSEDA trial

BACKGROUND

Critical illness is associated with severely impaired health-related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non-sedation versus sedation with a daily wake-up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub-study was to assess the effect of non-sedation on HRQoL and degree of independence in activities in daily living (ADL) 3 months post-ICU.

METHODS

All survivors were asked to complete the Medical Outcomes Study Short-Form 36 questionnaire (SF-36) and the Barthel Index 3 months post-ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL-function in each group. All outcomes were assessed blinded.

RESULTS

Of the 700 patients included 412 survived to follow-up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF-36 scores for the non-sedated vs sedated patients were as follows: Physical Function 45 vs 40, P = .69, Bodily Pain: 61 vs 52, P = .81, General Health: 50 vs 50, P = .84, Vitality: 42 vs 44, P = .85, Social Function: 75 vs 63, P = .85, Role Emotional: 58 vs 50, P = .82, Mental Health: 70 vs 70, P = .89, Role Physical: 25 vs 28, P = .32, Physical Component Score: 38 vs 37, P = .81, Mental Component Score: 48 vs 46, P = .94, Barthel Index: 20 vs 20, P = .74.

CONCLUSION

Randomization to non-sedation neither improved nor impaired health-related quality of life or degree of independence in activities in daily living 3 months post-ICU discharge.