Australian Regenerative Medicine Institute

Sleep in Critically III Chemically Paralyzed Patients Requiring Mechanical Ventilation: Patient Demographics

The NMBA administered was vecuronium by continuous infusion and titrated using the Dulin-Williams standard train-of-four protocol. The anxiolytic medication lorazepam was administered for sedation and titrated to a Ramsey score of 3 to 4. Morphine sulfate was administered intermittently or by continuous infusion for analgesia. All medication doses were recorded.
Data were collected from the patients’ record for severity of illness, admitting diagnosis, microbiology culture results, and laboratory chemistry. Severity of illness was measured by the calculated APACHE (acute physiology and chronic health evaluation) II score and the lung injury score (LIS).
Nonparametric analysis of variance (Kruskal-Wallis) test was used to detect a statistical difference between all three groups. The Dunn multiple comparison test was utilized to detect differences between groups. The Mann-Whitney rank-sum test was used to confirm intergroup results. Pearson correlation coefficient and linear regression (data were log transformed) were used to evaluate the association between APACHE II score, LIS, drug dosage, and TST and individual sleep stage, as well as the relationship between arousal and awakening scores and interventions (including mode of mechanical ventilation). Statistical analysis was performed by a statistician (SAS System Version 8; SAS Institute; Cary, NC). Here

A total of 20 patients were enrolled in the study. Eighteen patients underwent final analysis. One patient withdrew from the study after consent was obtained. The recorder malfunctioned during data acquisition in another patient. The study population characteristics are given in Table 1. Overall, ages ranged from 27 to 74 years with a younger population in the CS group (p < 0.02). When the one outlier, a 27-year-old patient, was eliminated from age analysis, no statistical difference existed between the groups. The IS and CS groups had more women than men, whereas the CS/NMBA group had almost all men. There was no correlation between age and TST or any stage of sleep. The majority of all patients were admitted for pneumonia. Concomitant diagnoses were present in all groups (COPD and pneumonia), and therefore the total number of diagnoses does not equal 18. In the CS/NMBA group, ARDS was present in five of six patients.

Table 1—Demographic Data

Characteristics IS Group CS Group CS/NMBA Group All Groups
Age, yr 58.5 ± 9.8 43.2 ± 13 61.3 ± 8.8 54 ± 13
Male/female gender, No. 1/5 2/4 5/1 8/10
ICU days 2.6 ± 0.8 5.5 ± 2.5 3.6 ± 2 3.9 ± 2
Mean arterial pressure, mm Hg 79 ± 10 88 ± 32 69.9 ± 5 78.9 ± 20
Heart rate, beats/min 104 ± 20 110 ± 14 102 ± 17 10.5 ± 17
Temperature, °C 37.4 ± 0.6 37.2 ± 0.6 37.6 ± 0.8 37.4 ± 0.2
Weight, kg 57.1 ± 14 83.4 ± 26 82.3 ± 15 74 ± 14
APACHE II scoref 11.5 ± 3.3 16.5 ± 7.7 22.1 ± 9.9 16.7 ± 8
LISt!§ 0.81 ± 0.6 1.46 ± 0.45 2.9 ± 1.14 1.7 ± 1
Diagnosis
Pneumonia 3(50) 3(50) 4 (66) 10 (55)
Asthma 0 2 (33) 0 1(5)
Sepsis syndrome 0 1(16) 2 (33) 3 (16)
COPD ‘ 2 (33) 1 (16) 1(16) 4 (22)
Amyotrophic lateral sclerosis 1(16) 0 0 1 (5)
Pulmonary edema 1(16) 0 0 1 (5)
ARDS 0 1 (16) 5 (83) 6 (33)
Positive culture results 3 (50) 5 (66) 2 (33) 10 (55)
Vasopressors 0 1 (16) 3 (50) 4 (22)
Death 0 1 (16) 3 (50) 4 (22)

Category: Respiratory Symptoms

Tags: ICU, mechanical ventilation, polysomnography, sleep