Australian Regenerative Medicine Institute

Sleep in Critically III Chemically Paralyzed Patients Requiring Mechanical Ventilation: Drug Dosage Between Groups

Drug dosage was compared using both absolute dosage and dose per body weight. There was no statistical difference in body weight between groups (p = 0.06). However, there was an observed lower body weight in the IS group compared to the other two groups (Table 1). Drug dosage differed significantly between the groups (Table 2). Patients in the CS group received the largest amount of sedation and narcotics. Patients in the CS/NMBA group received the least amount of narcotics. There was no statistically significant difference in sedation dose between the CS and CS/NMBA groups. Patients in the IS group were fully alert and able to request pain medication and received the least amount of both sedatives and narcotics. Four patients received sedation, and three of these patients received morphine concomitantly. The other two patients did not receive any drugs. In the CS group, all patients received both morphine and sedation. In the CS/ NMBA group, only three patients received morphine in addition to CS. One patient in the CS group received haloperidol for agitation. further

Sleep Stages Between Groups: All patients demonstrated abnormal sleep architecture by lack of sequential progression through sleep stages and abnormal distribution of sleep stage quantities compared with standard normative values. TST was increased in all groups compared to normative age-adjusted values. A nonsignificant trend (p = 0.06) of increasing TST, greatest in the CS/NMBA groups relative to the IS group, was noted (Table 3). Greater than 55% of the 24-h TST occurred during the daytime period in all groups (data not shown). A large variation in the quantity of each specific sleep stage occurred within each group and is reflected by the wide SD (Table 3). Stage 1 was increased only in the CS group. Stage 2 sleep was decreased in the CS group, and a wide variability (0.29 to 91%) existed. The standard Rechtschaffen and Kales delta activity was 31.9%, 48.9%, and 38.9% compared to mDelta activity of 32.9%, 49.6%, and 43.7% in the IS, CS, and CS/NMBA groups, respectively. Delta activity scored by either method was higher than published normative data (0 to 13%).

Table 2—Drug Dosages per Group

Drug IS Group CS Group CS/NMBAGroup p Value
Lorazepammg/kg/d 0.04 ± 0.04 0.72 ± 0.39 0.62 ± 0.20 < 0.001TJ
mg/d 4.4 58.5 52.3
Morphinemg/kg/d 0.11 ± 0.13 0.48 ± 0.52 0.14 ± 0.32 0.031f§
mg/d 6.1 39.8 12.8

Table 3—Sleep Architecture Between Groups

Variables Normal Values IS Group CS Group CS/NMBA Group p Value
TST, h 8 10.09 ± 6.4 14.1 ± 6.3 18.9 ± 4.7 0.07
Stage I, %f 2-7 5.8 ± 6.6 20.8 ± 35.5 7.4 ± 5.9 0.40
Stage II, %f 51-72 57.7 ± 23.8 28.24 ± 35 48.8 ± 22.3 0.20
Stage SWS-mDelta, %f 31.9 ± 24.6 49.6 ± 49 43.7 ± 28 0.90
Stage SWS-Rechtschaffen and Kales, %f** 0-13 31.9 ± 24.6 48.9 ± 50.5 38.9 ± 28.1 0.93
REM sleep, %f 17-25 3.6 ± 5.7 NA NA
Wake time, %{ 54.2 ± 22.7 36 ± 28 22 ± 12.5 0.07
Arousals per hour, No.|| 10-15 6.1 ± 2.4 5.0 ± 2.9 9.6 ± 10.8 0.80
Total arousals 05±85 121 ± 69 230 ± 106 0.58
Total awakenings 32.8 ± 10 58.3 ± 59 74.3 ± 53 0.32
Awakenings per hour 4.24 ± 2.4 4.79 ± 3.7 4.4 ± 3.7 0.90
Interventions 37.5 ± 16.7 71.5 ± 64 150 ± 140 0.02

Category: Respiratory Symptoms

Tags: ICU, mechanical ventilation, polysomnography, sleep