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You S, Xu F, Wu Y, Qin S, Shu B, Chen Y, Chen Y, Huang H, Duan G. Effect of noise isolation using noise-cancelling headphones during laparoscopic surgery for postoperative pain reduction: A randomized clinical trial. J Clin Anesth 2024; 92:111286. [PMID: 37837796 DOI: 10.1016/j.jclinane.2023.111286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
STUDY OBJECTIVE Most laparoscopic surgeries under general anesthesia are performed in noisy environments, although the effect of intraoperative noise reduction on postoperative pain remains uncertain. This study aimed to explore whether postoperative pain could be reduced through the intraoperative use of noise-cancelling headphones. DESIGN This study was conducted as a prospective parallel-group randomized clinical trial. SETTING Operating room and surgery room. PATIENTS Ninety patients who underwent laparoscopic surgery under general anesthesia. INTERVENTIONS In the intervention group, noise-cancelling headphones were used to reduce noise intensity during laparoscopic surgery under general anesthesia. MEASUREMENTS The primary outcome was the maximum movement-evoked pain intensity within 24 h post-surgery, measured using a 10-point numeric rating scale. Secondary outcomes included the maximum resting pain score and total opioid consumption during the 24-h period post-surgery. Mean intraoperative noise and the proportion of intraoperative time with noise intensity ≥70 dB were recorded. MAIN RESULTS The maximum movement-evoked pain score was significantly lower in the intervention group than in the control group (mean score [SD], 2.7 [1.0] and 4.0[1.0], respectively; P < 0.001). The intervention group required significantly fewer opioids than the control group (mean [SD], 44.2 [12.8] and 51.3[17.5] mg, respectively; P = 0.032). In the control group, but not the intervention group, all postoperative pain scores were significantly associated with the proportion of intraoperative time with noise intensity ≥70 dB, which was an independent risk factor for postoperative pain. CONCLUSION During laparoscopic surgery under general anesthesia, intraoperative noise isolation using noise-cancelling headphones is a safe and effective strategy for relieving postoperative pain and decreasing total opioid analgesic consumption.
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Affiliation(s)
- Shuai You
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Fang Xu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yingcai Wu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Siyu Qin
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Shu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yupei Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
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Kalvas LB, Harrison TM, Curley MAQ, Ordway MR, Redeker NS, Happ MB. An observational pilot study of sleep disruption and delirium in critically ill children. Heart Lung 2023; 62:215-224. [PMID: 37591147 PMCID: PMC10592139 DOI: 10.1016/j.hrtlng.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Sleep disruption is frequently observed in children with delirium in the pediatric intensive care unit (PICU). OBJECTIVES This observational pilot study explores relationships among modifiable characteristics of the PICU environment (i.e., light, sound, clinician caregiving patterns), sleep disruption, and delirium. METHODS Ten children, 1 to 4 years old, were recruited within 48 h of PICU admission and followed until discharge. A light meter, dosimeter, and video camera were placed at bedside to measure PICU environmental exposures. Sleep was measured via actigraphy. Twice daily delirium screening was conducted. Descriptive statistics were used to describe the PICU environment, sleep, and delirium experienced by children. Bivariate analyses were performed to determine relationships among variables. RESULTS Average participant age was 21 (SD = 9.6) months. Eight (80%) were admitted for respiratory failure. Median PICU length of stay was 36.7 (IQR[29.6, 51.5]) hours, which limited data collection duration. Delirium prevalence was 60% (n = 6). Children experienced low daytime light levels (x¯ = 112.8 lux, SD = 145.5) and frequent peaks (x¯ = 1.9/hr, SD = 0.5) of excessive sound (i.e., ≥ 45 A-weighted decibels). Clinician caregiving episodes were frequent (x¯ = 4.5/hr, SD = 2.6). Children experienced 7.3 (SD = 2.1) awakenings per hour of sleep and a median sleep episode duration of 1.4 (IQR[0.6, 2.3]) hours. On average, children with delirium experienced 1.1 more awakenings per sleep hour and 42 fewer minutes of sleep per sleep episode during the night shift. Increased clinician care frequency and duration were associated with worse sleep quality and delirium. CONCLUSIONS Study results will inform future, large-scale research and nurse-driven sleep promotion interventions.
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Affiliation(s)
- Laura Beth Kalvas
- The Ohio State University Center for Clinical and Translational Science, 236A Newton Hall, 333 W. 10th Ave., Columbus, OH, 43210, USA.
| | - Tondi M Harrison
- The Ohio State University College of Nursing, 360 Newton Hall, 1585 Neil Avenue, Columbus OH 43210, USA
| | - Martha A Q Curley
- Ruth M. Colket Endowed Chair in Pediatric Nursing, Children's Hospital of Philadelphia, PA 19104, USA; University of Pennsylvania School of Nursing, 425 Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA
| | - Monica R Ordway
- Yale School of Nursing, Office 21403, 400 West Campus Drive, Orange, CT 06477, USA
| | - Nancy S Redeker
- University of Connecticut School of Nursing, 313 Augustus Storrs Hall, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, USA
| | - Mary Beth Happ
- The Ohio State University College of Nursing, 360 Newton Hall, 1585 Neil Avenue, Columbus OH 43210, USA
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3
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Mistry D, Ahmed U, Aujla R, Aslam N, D'Alessandro P, Malik S. The relationship between exposure to noise and hearing loss in orthopaedics. Bone Joint J 2023; 105-B:602-609. [PMID: 37257856 DOI: 10.1302/0301-620x.105b6.bjj-2022-0921.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims In the UK, the agricultural, military, and construction sectors have stringent rules about the use of hearing protection due to the risk of noise-induced hearing loss. Orthopaedic staff may also be at risk due to the use of power tools. The UK Health and Safety Executive (HSE) have clear standards as to what are deemed acceptable occupational levels of noise on A-weighted and C-weighted scales. The aims of this review were to assess the current evidence on the testing of exposure to noise in orthopaedic operating theatres to see if it exceeds these regulations. Methods A search of PubMed and EMBASE databases was conducted using PRISMA guidelines. The review was registered prospectively in PROSPERO. Studies which assessed the exposure to noise for orthopaedic staff in operating theatres were included. Data about the exposure to noise were extracted from these studies and compared with the A-weighted and C-weighted acceptable levels described in the HSE regulations. Results A total of 15 studies were deemed eligible. These included a total of 386 orthopaedic operations and the use of 64 orthopaedic instruments. A total of 294 operations (76%) and 45 instruments (70%) exceeded the regulations on an A-weighted scale, and 22% (10 of 46) of operations exceeded the maximum C-weighted peak acceptable level of noise. Noise-induced hearing loss was reported in 28 of 55 orthopaedic staff members (50.9%). Conclusion Safe levels of noise can be exceeded in orthopaedic operations, and when using orthopaedic instruments. Employers have clear policies about exposure to noise in the workplace but have yet to identify orthopaedic theatres as a potential at-risk area. Orthopaedic staff need education, monitoring, and protection, while employers should consider regular assessments of staff in orthopaedic theatres and offer methods to prevent noise-induced hearing loss.
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Affiliation(s)
- Dylan Mistry
- Worcester Acute Hospitals NHS Trust, Worcester, UK
| | - Usman Ahmed
- Worcester Acute Hospitals NHS Trust, Worcester, UK
| | | | - Nadim Aslam
- Worcester Acute Hospitals NHS Trust, Worcester, UK
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Knauert MP, Ayas NT, Bosma KJ, Drouot X, Heavner MS, Owens RL, Watson PL, Wilcox ME, Anderson BJ, Cordoza ML, Devlin JW, Elliott R, Gehlbach BK, Girard TD, Kamdar BB, Korwin AS, Lusczek ER, Parthasarathy S, Spies C, Sunderram J, Telias I, Weinhouse GL, Zee PC. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e49-e68. [PMID: 36999950 PMCID: PMC10111990 DOI: 10.1164/rccm.202301-0184st] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.
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Naef AC, Knobel SEJ, Ruettgers N, Jeitziner MM, Holtforth MG, Zante B, Schefold JC, Nef T, Gerber SM. Methods for Measuring and Identifying Sounds in the Intensive Care Unit. Front Med (Lausanne) 2022; 9:836203. [PMID: 35733869 PMCID: PMC9207602 DOI: 10.3389/fmed.2022.836203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference. Methods The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time. Results The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (LAeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively. Conclusion A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.
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Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Stephan M. Gerber
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Topcu N, Tosun Z. Efforts to improve sleep quality in a medical intensive care unit: effect of a protocol of non-pharmacological interventions. Sleep Breath 2022; 26:803-810. [PMID: 35146570 DOI: 10.1007/s11325-022-02570-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to evaluate the effect of a protocol of nonpharmacological interventions to improve sleep quality in the intensive care unit (ICU). Due to its close relationship with sleep quality, the effects of the same interventions on noise levels and delirium rates were also evaluated in this study. METHODS This pretest-posttest design with a control group was carried out in a medical ICU over 8 months. Data were collected using Acute Physiology and Chronic Health Evaluation II, the Glasgow Coma Scale, the Richmond Agitation-Sedation Scale, the Richards-Campbell Sleep Questionnaire (RCSQ), the Confusion Assessment Method for the Intensive Care Unit, and noise measurement devices. In the first phase of the study, patients receiving standard care in the ICU were followed. After the first stage, a training session was held for nurses to raise awareness and information. Then, the sleep-promoting protocol created by the researchers was applied. The ambient noise level was measured continuously. RESULTS A total of 78 patients with a mean age of 70.0 ± 13.2 years were followed in the ICU for an average of 7.3 ± 3.8 days. With protocol implementation, the ambient noise level in the ICU was reduced from 70.9 ± 3.8 dB(A) to 62.7 ± 3.5 dB(A) (p < 0.01); the RCSQ scores of the patients increased from 48.3 ± 1.4 to 62.1 ± 1.8 (p < 0.01). Although statistically nonsignificant, efforts to improve sleep quality also reduced the development of delirium by 15%. CONCLUSION It is possible to improve sleep quality and reduce noise levels in an ICU with a protocol consisting of multicomponent nonpharmacological interventions.
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Affiliation(s)
- Nihal Topcu
- Tekirdag Dr. Ismail Fehmi Cumalıoğlu City Hospital, Tekirdag, Turkey
| | - Zeynep Tosun
- Tekirdag Namik Kemal University Health College Nursing Department, Tekirdag, Turkey.
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7
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Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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Harley JJ, Rowden LJ, Clifforde LM, Power A, Stanley CR. Preliminary investigation of the effects of a concert on the behavior of zoo animals. Zoo Biol 2022; 41:308-327. [PMID: 35137965 PMCID: PMC9546360 DOI: 10.1002/zoo.21676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/17/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
To increase visitor footfall and engagement, zoos may host public events that may extend outside typical opening hours. With plans to hold a 2‐day concert at Tayto Park, Ireland, this study aimed to identify the behavioral response to the music event of a selected group of species in the zoo. Twenty‐two species were observed across three phases of the event (pre‐, during, and post event). Specific behaviors of interest were categorized as active, resting, asleep, abnormal, and out of sight, with repeated observations being made at each enclosure during each phase. Alongside these behavioral data, sound pressure levels (SPLs) were concurrently recorded at the observation locations in terms of both dB(A) and dB(C). The median dB(C) levels during the event were found to be significantly higher (mdn = 64.5 dB) when compared with both pre‐event (mdn = 60.7 dB) and postevent phases (mdn = 59.4 dB), while dB(A) levels were only significantly higher during the event (51.7 dB) when compared with the pre‐event phase (mdn = 49.8 dB). We found some species‐specific behavioral changes (mainly associated with active and resting behaviors) correlated with increased SPLs and/or event itself. However, the behavioral responses varied between species and there were numerous species that did not respond with any change in behavior to the increased SPLs or the event itself. This variation in response across species reinforces the need for monitoring of behavioral changes as well as consideration of their natural behavioral ecology when implementing appropriate mitigation strategies. Further research should be encouraged to provide an evidence‐based assessment of how music events may affect animal welfare and behavior and to test the efficacy of mitigation strategies that are implemented to safeguard animal welfare. We found several species expressed behavioral changes that correlated with increased noise and/or other aspects of a public event. The nature of these responses varied across species. Many species did not show any change in behavior during the event. Habitual resting/active periods may have changed due to extended opening hours. The onset of sleep behavior in vultures occurred later during the event compared with the pre‐event phase. Porcupines emerged from their dens later during the event compared to pre‐ or postevent phases. Predetermined maximum sound pressure limits for animal enclosures were not exceeded, confirming that precautionary measures, that is, soundproofing, location, stage position, and other mitigations, provided effective control of noise propagation in the zoo.
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Affiliation(s)
- Jessica J Harley
- Animal Behavior & Welfare Research Group, Department of Biological Sciences, University of Chester, Chester, UK.,Knowsley Safari, Merseyside, Prescot, UK
| | | | | | - Aisling Power
- Department of Conservation, Education & Research, Tayto Park Co., Meath, Ireland
| | - Christina R Stanley
- Animal Behavior & Welfare Research Group, Department of Biological Sciences, University of Chester, Chester, UK
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Lusczek ER, Parsons LS, Elder J, Harvey SB, Skube M, Muratore S, Beilman G, Cornelissen-Guillaume G. Metabolomics Pilot Study Identifies Desynchronization of 24-H Rhythms and Distinct Intra-patient Variability Patterns in Critical Illness: A Preliminary Report. Front Neurol 2020; 11:533915. [PMID: 33123071 PMCID: PMC7566909 DOI: 10.3389/fneur.2020.533915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/24/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Synchronized circadian rhythms play a key role in coordinating physiologic health. Desynchronized circadian rhythms may predispose individuals to disease or be indicative of underlying disease. Intensive care unit (ICU) patients likely experience desynchronized circadian rhythms due to disruptive environmental conditions in the ICU and underlying pathophysiology. This observational pilot study was undertaken to determine if 24-h rhythms are altered in ICU patients relative to healthy controls by profiling 24-h rhythms in vital signs and plasma metabolites. Methods: We monitored daily rhythms in 5 healthy controls and 5 ICU patients for 24 h. Heart rate and blood pressure were measured every 30 min, temperature was measured every hour, and blood was sampled for mass spectrometry-based plasma metabolomics every 4 h. Bedside sound levels were measured every minute. Twenty-four hours rhythms were evaluated in vitals and putatively identified plasma metabolites individually and in each group using the cosinor method. Results: ICU patient rooms were significantly louder than healthy controls' rooms and average noise levels were above EPA recommendations. Healthy controls generally had significant 24-h rhythms individually and as a group. While a few ICU patients had significant 24-h rhythms in isolated variables, no significant rhythms were identified in ICU patients as a group, except in cortisol. This indicates a lack of coherence in phases and amplitudes among ICU patients. Finally, principal component analysis of metabolic profiles showed surprising patterns in plasma sample clustering. Each ICU patient's samples were clearly discernable in individual clusters, separate from a single cluster of healthy controls. Conclusions: In this pilot study, ICU patients' 24-h rhythms show significant desynchronization compared to healthy controls. Clustering of plasma metabolic profiles suggests that metabolomics could be used to track individual patients' clinical courses longitudinally. Our results show global disordering of metabolism and the circadian system in ICU patients which should be characterized further in order to determine implications for patient care.
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Affiliation(s)
- Elizabeth R Lusczek
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Lee S Parsons
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, United States
| | - Jesse Elder
- Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
| | - Stephen B Harvey
- Center for Mass Spectrometry and Proteomics, University of Minnesota, Minneapolis, MN, United States
| | - Mariya Skube
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Sydne Muratore
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Greg Beilman
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
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10
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Dornbusch J, Boston S, Colee J. Noise levels in an academic veterinary intensive care unit. J Vet Emerg Crit Care (San Antonio) 2020; 30:632-637. [PMID: 32965081 DOI: 10.1111/vec.12997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/03/2019] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To quantify the noise levels in a veterinary Intensive Care Unit (ICU) and ascertain how they compare to current recommendations in the human literature. DESIGN A Larson Davis SoundTrack LXT Sound Meter device measured noise levels in a veterinary ICU for 41 days. SETTING Specialty referral academic small animal teaching hospital ICU. ANIMALS Passive involvement of dogs and cats housed in the ICU during the study period of 41 days. INTERVENTIONS No alterations to the hospital environment or patient care were made. MEASUREMENTS A-weighted average (LAeq) and maximum decibel measurements (LFmax) were recorded. The data were analyzed to look for correlations in elevated noise levels with the number and type of patients hospitalized, the time of day, and whether it was a weekday or weekend. MAIN RESULTS The average, median, and maximum decibel levels measured in our ICU were 76.97 dB(A), 76.13 dB(A), and 86.54 dB(A), respectively, for the duration of this study. The time frames of 6:00 am to 9:00 am and 6:00 pm to 9:00 pm were associated with higher decibel levels in this study. CONCLUSIONS The noise levels recorded in this study exceed the World Health Organization recommendations for noise levels in hospital care settings and are higher than the previously reported elevated noise levels in 2 veterinary referral private practice ICUs. Increased noise levels in veterinary ICUs may have adverse effects on our veterinary patients and staff and warrant further investigation.
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Affiliation(s)
- Josephine Dornbusch
- Department of Small Animal Clinical Sciences, The University of Florida, College of Veterinary Medicine, Gainsville, FL
| | - Sarah Boston
- Department of Small Animal Clinical Sciences, The University of Florida, College of Veterinary Medicine, Gainsville, FL
| | - James Colee
- IFAS Statistical Consulting Unit, University of Florida, Gainesville, Florida
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Azimaraghi O, Hammer M, Santer P, Platzbecker K, Althoff FC, Patrocinio M, Grabitz SD, Wongtangman K, Rumyantsev S, Xu X, Schaefer MS, Fuller PM, Subramaniam B, Eikermann M. Study protocol for a randomised controlled trial evaluating the effects of the orexin receptor antagonist suvorexant on sleep architecture and delirium in the intensive care unit. BMJ Open 2020; 10:e038474. [PMID: 32690536 PMCID: PMC7371384 DOI: 10.1136/bmjopen-2020-038474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Insomnia frequently occurs in patients admitted to an intensive care unit (ICU). Sleep-promoting agents may reduce rapid eye movement sleep and have deliriogenic effects. Suvorexant (Belsomra) is an orexin receptor antagonist with Food and Drug Administration (FDA) approval for the treatment of adult insomnia, which improves sleep onset and maintenance as well as subjective measures of quality of sleep. This trial will evaluate the efficacy of postoperative oral suvorexant treatment on night-time wakefulness after persistent sleep onset as well as the incidence and duration of delirium among adult cardiac surgical patients. METHODS AND ANALYSIS In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 120 patients, aged 60 years or older, undergoing elective cardiac surgery with planned postoperative admission to the ICU. Participants will be randomised to receive oral suvorexant (20 mg) or placebo one time a day starting the night after extubation. The primary outcome will be wakefulness after persistent sleep onset. The secondary outcome will be total sleep time. Exploratory outcomes will include time to sleep onset, incidence of postoperative in-hospital delirium, number of delirium-free days and subjective sleep quality. ETHICS AND DISSEMINATION Ethics approval was obtained through the 'Committee on Clinical Investigations' at Beth Israel Deaconess Medical Center (protocol number 2019P000759). The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER This trial has been registered at clinicaltrials.gov on 17 September 2019 (NCT04092894).
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Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maximilian Hammer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Friederike C Althoff
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Patrocinio
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Karuna Wongtangman
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sandra Rumyantsev
- Pharmacy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick M Fuller
- Department of Neurology, Program in Neuroscience and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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12
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Redeker NS. Sensor technology for nursing research. Nurs Outlook 2020; 68:711-719. [PMID: 32580871 DOI: 10.1016/j.outlook.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Electronic sensors measuring biological and behavioral aspects of health and the environment are becoming ubiquitous and, with advances in data science and ehealth technology, provide opportunities for new inquiry and innovative approaches to nursing research. PURPOSE To conceptualize the use of sensor technology from the perspective of nursing science. METHODS This review reports the keynote presentation from the Expanding Science of Sensor Technology in Nursing Research Conference presented by the Council for Advancement of Nursing Science in 2019 FINDINGS: Electronic sensors enable collection, recording, and transmission of data in real time in real life settings, remote monitoring, self-monitoring, and communication between health care professionals and patients. A deliberative approach to selecting and applying electronic sensors and analyzing and interpreting the data is needed for successful research. DISCUSSION Electronic sensors have high potential to advance nursing science.
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Affiliation(s)
- Nancy S Redeker
- Yale School of Nursing, Yale School of Medicine, Department of Internal Medicine, Yale University, West Haven CT.
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Greenfield KD, Karam O, Iqbal O'Meara AM. Brighter Days May Be Ahead: Continuous Measurement of Pediatric Intensive Care Unit Light and Sound. Front Pediatr 2020; 8:590715. [PMID: 33194924 PMCID: PMC7649178 DOI: 10.3389/fped.2020.590715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To describe light and sound characteristics in the rooms of critically ill children. Design: Prospective observational cohort study, with continuously measured light and sound levels. Setting: Tertiary care pediatric intensive care unit (PICU), with a newly constructed expansion and an older, pre-existing section. Patients: Critically ill patients 0-18 years old, requiring respiratory or cardiovascular support. Patients with severe cognitive pre-conditions were excluded. Measurements and Main Results: One hundred patients were enrolled, totaling 602 patient-days. The twenty-four hour median illuminance was 16 (IQR 5-53) lux (lx). Daytime (07:00-21:00) median light level was 27 lx (IQR 13-82), compared with 4 lx (IQR 1-10) overnight (22:00-06:00). Peak light levels occurred midday between 11:00 and 14:00, with a median of 48 lx (IQR 24-119). Daytime median illuminance trended higher over the course of admission, whereas light levels overnight were consistent. Midday light levels were higher in newly constructed rooms: 78 lx (IQR 30-143) vs. 26 lx (IQR 20-40) in existing rooms. The twenty-four hour median equivalent sound level (LAeq) was 60 (IQR 55-64) decibels (dB). Median daytime LAeq was 62 dB (IQR 58-65) and 56 dB (IQR 52-61) overnight. On average, 35% of patients experienced at least one sound peak >80 dB every hour from 22:00 to 06:00. Overnight peaks, but not median sound levels nor daytime peaks, decreased over the course of admission. There was no difference in sound between new and pre-existing rooms. Conclusions: This study describes continuously measured light and sound in PICU rooms. Light levels were low even during daytime hours, while sound levels were consistently higher than World Health Organization hospital room recommendations of <35 dB. Given the relevance of light and sound to sleep/wake patterns, and evidence of post-intensive care syndromes, the clinical effects of light and sound on critically ill children should be further explored as potentially modifiable environmental factors.
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Affiliation(s)
- Kara D Greenfield
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| | - Oliver Karam
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| | - A M Iqbal O'Meara
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
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14
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Pisani MA, D'Ambrosio C. Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review. Chest 2019; 157:977-984. [PMID: 31874132 DOI: 10.1016/j.chest.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
Sleep is important to health and well-being, and studies in healthy adults have demonstrated that sleep deprivation impacts respiratory, immune, and cognitive function. Historically, because of the nature of critical illness, sleep has not been considered a priority for patient care in the ICU. More recently, research has demonstrated that sleep is markedly abnormal in patients who are critically ill. In addition, there is often disruption of circadian rhythms. Delirium is a syndrome of acute alteration in mental status that occurs in the setting of contributing factors such as serious illness, medication, and drug or alcohol intoxication or withdrawal. Delirium is a frequent occurrence in critical illness, and research has demonstrated several adverse outcomes associated with delirium including persistent cognitive impairment and increased mortality. Sleep deprivation and delirium share many common symptoms. The similarity in symptoms between sleep disruption and delirium have prompted experts to draw links between the two and question both the relationship and its direction. In addition, the inclusion of sleep disturbance to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition in its constellation of symptoms used in diagnosing delirium has increased awareness of the link between sleep and delirium. This paper will review the literature on sleep in critical illness and the potential mechanisms and pathways that may connect sleep and delirium.
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15
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Wallis R, Harris E, Lee H, Davies W, Astin F. Environmental noise levels in hospital settings: A rapid review of measurement techniques and implementation in hospital settings. Noise Health 2019; 21:200-216. [PMID: 32820743 PMCID: PMC7650850 DOI: 10.4103/nah.nah_19_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 12/31/2019] [Accepted: 01/16/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Hospitals provide treatment to improve patient health and well-being but the characteristics of the care environment receive little attention. Excessive noise at night has a negative impact on in-patient health through disturbed sleep. To address this hospital staff must measure night-time environmental noise levels. Therefore, an understanding of environmental noise measurement techniques is required. In this review, we aim to 1) provide a technical overview of factors to consider when measuring environmental noise in hospital settings; 2) conduct a rapid review on the equipment and approaches used to objectively measured noise in hospitals and identify methodological limitations. DESIGN : A rapid review of original research articles, from three databases, published since 2008. Studies were included if noise levels were objectively measured in a hospital setting where patients were receiving treatment. RESULTS 1429 articles were identified with 76 included in the review. There was significant variability in the approaches used to measure environmental noise in hospitals. Only 14.5% of studies contained sufficient information to support replication of the measurement process. Most studies measured noise levels using a sound level meter positioned closed to a patient's bed area in an intensive care unit. CONCLUSION : Unwanted environmental noise in hospital setting impacts negatively on patient and staff health and well-being. However, this literature review found that the approaches used to objectively measure noise level in hospital settings have been inconsistent and poorly reported. Recommendations on best-practice methods to measure noise levels in hospital environments are provided.
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Affiliation(s)
- Rory Wallis
- Applied Psychoacoustics Laboratory, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - Emma Harris
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - Hyunkook Lee
- Applied Psychoacoustics Laboratory, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
| | - William Davies
- Acoustics Research Centre, University of Salford, Salford, M5 4WT, United Kingdom
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield, Huddersfield, HD1 3DH, United Kingdom
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16
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Knauert MP, Pisani M, Redeker N, Murphy T, Araujo K, Jeon S, Yaggi H. Pilot study: an intensive care unit sleep promotion protocol. BMJ Open Respir Res 2019; 6:e000411. [PMID: 31258916 PMCID: PMC6561389 DOI: 10.1136/bmjresp-2019-000411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Disturbances, such as in-room activity and sound, are significant sources of sleep disruption among critically ill patients. These factors are potentially modifiable. We tested the impact of an intensive care unit (ICU) sleep promotion protocol on overnight in-room disturbance. Methods Our protocol restricted non-urgent bedside care from 00:00 to 03:59. Patients were assigned to usual care (n=30) or the sleep protocol (n=26). The primary outcomes were measures of in-room activity, sound and light. These three types of disturbance were compared between arms during a baseline time block (20:00–23:59) and a rest time block (00:00–03:59). We assessed the sleep protocol effect with generalised linear models. Results Usual care and sleep protocol patients had equivalent levels of in-room activity, sound and light during the baseline time block (20:00–23:59). In contrast, during the rest time block (00:00–03:59), the sleep protocol arm had 32% fewer room entries (rate ratio (RR) 0.68, p=0.001) and 9.1 fewer minutes of in-room activity (p=0.0002). Also, the length of time between room entrances increased from 26.4 to 45.8 min (p=0.0004). The sleep protocol arm also had lower sound during the rest time block. Mean A-weighted sound was 2.5 decibels lower (p=0.02), and there were 36% fewer peaks (RR 0.64, p=0.02). Light levels were highly variable and not changed by the sleep protocol. Conclusions Sleep promotion protocols can improve in-room activity and sound. This provides a better sleep opportunity and may, therefore, improve ICU sleep. Trial registration number 1112009428
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Affiliation(s)
- Melissa P Knauert
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Margaret Pisani
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Nancy Redeker
- Division of Acute Care/Health Systems, Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Terry Murphy
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katy Araujo
- Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sangchoon Jeon
- Division of Acute Care/Health Systems, Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Henry Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Darbyshire JL, Müller-Trapet M, Cheer J, Fazi FM, Young JD. Mapping sources of noise in an intensive care unit. Anaesthesia 2019; 74:1018-1025. [PMID: 31066046 PMCID: PMC6767712 DOI: 10.1111/anae.14690] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2019] [Indexed: 11/30/2022]
Abstract
Excessive noise in hospitals adversely affects patients' sleep and recovery, causes stress and fatigue in staff and hampers communication. The World Health Organization suggests sound levels should be limited to 35 decibels. This is probably unachievable in intensive care units, but some reduction from current levels should be possible. A preliminary step would be to identify principal sources of noise. As part of a larger project investigating techniques to reduce environmental noise, we installed a microphone array system in one with four beds in an adult general intensive care unit. This continuously measured locations and sound pressure levels of noise sources. This report summarises results recorded over one year. Data were collected between 7 April 2017 and 16 April 2018 inclusive. Data for a whole day were available for 248 days. The sound location system revealed that the majority of loud sounds originated from extremely limited areas, very close to patients' ears. This proximity maximises the adverse effects of high environmental noise levels for patients. Some of this was likely to be appropriate communication between the patient, their caring staff and visitors. However, a significant proportion of loud sounds may originate from equipment alarms which are sited at the bedside. A redesign of the intensive care unit environment to move alarm sounds away from the bed-side might significantly reduce the environmental noise burden to patients.
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Affiliation(s)
- J L Darbyshire
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | | | - J Cheer
- Institute of Sound and Vibration Research, Southampton University, Southampton, UK
| | - F M Fazi
- Institute of Sound and Vibration Research, Southampton University, Southampton, UK
| | - J D Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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18
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Altman MT, Pulaski C, Mburu F, Pisani MA, Knauert MP. Non-circadian signals in the intensive care unit: Point prevalence morning, noon and night. Heart Lung 2018; 47:610-615. [PMID: 30143362 DOI: 10.1016/j.hrtlng.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/30/2018] [Accepted: 07/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Intensive care unit (ICU) sleep disturbance is severe and potentially related to abnormal light and sound exposure. OBJECTIVES To assess the prevalence of measures of light and sound disturbance in ICU patient rooms, and whether these could be modified by a sleep-promotion intervention. METHODS This observational study with a before and after design for a quality improvement initiative surveyed environmental factors in ICU rooms at 01:00 08:00, and 12:00. Surveys assessed light usage, television usage, window shade position, and room door/curtain position. Factors were compared before and after an ICU sleep-promotion intervention. RESULTS 990 (pre-intervention) and 819 (post-intervention) occupied rooms were surveyed. Pre-intervention, the prevalence of night-time factors included: bright lights on (21%), television on (46%), and room door open (94%). Post-intervention, more rooms had all lights off at night (41% v 50%, p = 0.04), and fewer rooms had open door curtains (57% v 42%, p = 0.001) and window shades (78% v 62%, p = 0.002). CONCLUSIONS Disruptive environmental factors are common in the ICU. Some factors improve with sleep-promotion interventions.
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Affiliation(s)
- Marcus T Altman
- Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, United States
| | - Catherine Pulaski
- Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; P.O. Box 208057, New Haven, CT 06520-8057, United States
| | - Francis Mburu
- Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; P.O. Box 208057, New Haven, CT 06520-8057, United States
| | - Margaret A Pisani
- Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; P.O. Box 208057, New Haven, CT 06520-8057, United States
| | - Melissa P Knauert
- Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine; P.O. Box 208057, New Haven, CT 06520-8057, United States.
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19
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Knauert MP, Redeker NS, Yaggi HK, Bennick M, Pisani MA. Creating Naptime: An Overnight, Nonpharmacologic Intensive Care Unit Sleep Promotion Protocol. J Patient Exp 2018; 5:180-187. [PMID: 30214923 PMCID: PMC6134539 DOI: 10.1177/2374373517747242] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Patients in the intensive care unit (ICU) have significantly disrupted sleep. Sleep
disruption is believed to contribute to ICU delirium, and ICU delirium is associated
with increased mortality. Experts recommend sleep promotion as a means of preventing or
shortening the duration of delirium. ICU Sleep promotion protocols are highly complex
and difficult to implement. Our objective is to describe the development, pilot
implementation, and revision of a medical ICU sleep promotion protocol. Methods: Naptime is a clustered-care intervention that provides a rest period
between 00:00 and 04:00. We used literature review, medical chart review, and
stakeholder interviews to identify sources of overnight patient disturbance. With
stakeholder input, we developed an initial protocol that we piloted on a small scale.
Then, using protocol monitoring and stakeholder feedback, we revised
Naptime and adapted it for unitwide implementation. Results: We identified sound, patient care, and patient anxiety as important sources of
overnight disturbance. The pilot protocol altered the timing of routine care with a
focus on medications and laboratory draws. During the pilot, there were frequent
protocol violations for laboratory draws and for urgent care. Stakeholder feedback
supported revision of the protocol with a focus on providing 60- to 120-minute rest
periods interrupted by brief clusters of care between 00:00 and 04:00. Discussion: Four-hour blocks of rest may not be possible for all medical ICU patients, but
interruptions can be minimized to a significant degree. Involvement of all stakeholders
and frequent protocol reevaluation are needed for successful adoption of an overnight
rest period.
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Affiliation(s)
- Melissa P Knauert
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nancy S Redeker
- Yale School of Nursing, Yale University West Campus, West Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry K Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Michael Bennick
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Margaret A Pisani
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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20
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Iyendo TO. Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study. Complement Ther Clin Pract 2017; 29:58-96. [PMID: 29122270 DOI: 10.1016/j.ctcp.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment. METHODS Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar. RESULTS Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff. CONCLUSIONS Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.
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Voigt LP, Reynolds K, Mehryar M, Chan WS, Kostelecky N, Pastores SM, Halpern NA. Monitoring sound and light continuously in an intensive care unit patient room: A pilot study. J Crit Care 2016; 39:36-39. [PMID: 28167378 DOI: 10.1016/j.jcrc.2016.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE To determine the feasibility of continuous recording of sound and light in the intensive care unit (ICU). MATERIALS AND METHODS Four 1-hour baseline scenarios in an empty ICU patient room by day and night (doors open or closed and maximal or minimal lighting) and two daytime scenarios simulating a stable and unstable patient (quiet or loud devices and staff) were conducted. Sound and light levels were continuously recorded using a commercially available multisensor monitor and transmitted via the hospital's network to a cloud-based data storage and management system. RESULTS The empty ICU room was loud with similar mean sound levels of 45 to 46 dBA for the day and night simulations. Mean levels for maximal lighting during day and night ranged from 1306 to 1812 lux and mean levels for minimum lighting were 1 to 3 lux. The mean sound levels for the stable and unstable patient simulations were 61 and 81 dBA, respectively. The mean light levels were 349 lux for the stable patient and 1947 lux for the unstable patient. CONCLUSIONS Combined sound and light can be continuously and easily monitored in the ICU setting. Incorporating sound and light monitors in ICU rooms may promote an enhanced patient- and staff-centered healing environment.
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Affiliation(s)
- Louis P Voigt
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Kelly Reynolds
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maryam Mehryar
- Biomedical Engineering Service, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Wai Soon Chan
- Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Natalie Kostelecky
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen M Pastores
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil A Halpern
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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