Sleep in Critically III Chemically Paralyzed Patients Requiring Mechanical Ventilation: Study Site
The study was performed between June 1, 1999, and December 31, 2000, in the adult medical ICU at the University of California, Davis. The study protocol and consent form were approved by the Institutional Review Board of the Human Subjects Committee. Written informed consent was obtained from the patient or family member if the patient had any altered sensorium or was unable to read or write. All patients were in private rooms that were enclosed on three sides and separated from the nursing station and equipment room by a sliding glass door. All rooms had windows and were similarly located with respect to external noise sources.
Three groups of patients (n = 6 per group) with respiratory failure were prospectively studied to discriminate the effects of sedation, narcotics, and NMBAs on polysomnographic results. Patients were screened for eligibility to the study within 48 h of hospital admission. Inclusion criteria required intubation within 24 h of admission, anticipated mechanical ventilation for > 48 h, and a medication regimen set a priori into one of the following three categories: group 1 (intermittent sedation [IS]), consisting of patients who received only IS or pain medication. These patients were fully awake, alert, and able to follow commands. Group 2 (continuous sedation [CS]) consisted of patients who were receiving IV CS without any paralytic agent. Group 3 (CS/NMBA) consisted of patients who received both IV CS and an NMBA. itat on
Exclusion criteria for all groups were the presence of head trauma, psychiatric illness (including use of antidepressant medications), anoxic brain injury, suspected encephalopathy (drug overdose, hepatic failure), seizure disorder, and severe hemodynamic instability in whom systolic BP was < 90 mm Hg despite vasopressor support. Oxygen saturation levels were > 90% in all patients. All patient-care treatment decisions, including assignment to IS, CS, and CS/NMBA groups, were determined by the critical care attending physician and were not altered by any investigator during the study.
Category: Respiratory Symptoms
Tags: ICU, mechanical ventilation, polysomnography, sleep