The association of sleep quality, delirium, and sedation status with daily participation in physical therapy in the ICU
The association of sleep quality, delirium, and sedation status with daily participation in physical therapy in the ICU
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DOI：
10.1186/s13054-016-1433-z
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发表时间：
2016-08-18
期刊：
影响因子：
15.1
通讯作者：
Needham, Dale M.
中科院分区：
文献类型：
--
作者：
Kamdar, Biren B.;Combs, Michael P.;Needham, Dale M.
背景资料：睡眠不佳在ICU环境中很常见，可能是患者参与ICU物理治疗（PT）干预的一个可改变的风险因素。本研究评估了相关的感知睡眠质量，谵妄，镇静，和其他临床上重要的病人和ICU因素与参与物理治疗（PT）interventions. Method：这是一个二次分析的前瞻性观察性研究睡眠在一个单一的学术医疗ICU（MICU）。使用Richards-Campbell睡眠问卷（RCSQ）评估感知睡眠质量，使用ICU混乱评估方法（CAM-ICU）评估谵妄。其他协变量包括人口统计学、住院前Ambassador状态、ICU入院诊断、每日机械通气状态以及每日通过推注和连续输注给予苯二氮卓类药物和阿片类药物。与参与PT干预的关联进行了评估，符合PT的患者使用多项马尔可夫模型与强大的方差estimation.Results：总体而言，327个连续的MICU患者完成了>= 1评估感知的睡眠质量。调整所有协变量后，每日评估感知睡眠质量与第二天过渡到参与PT无关（相对风险比[RRR] 1.02，95% CI 0.96 - 1.07，p = 0.55）。然而，以下因素与参与后续PT干预有显著的负相关性：谵妄（RRR 0.58，95% CI 0.41 - 0.76，p <0.001），阿片类药物推注（RRR 0.68，95% CI 0.47 - 0.99，p = 0.04）和持续镇静输注（RRR 0.58，95% CI 0.40 - 0.85，p = 0.01）。此外，在谵妄患者中，苯二氮卓类药物推注进一步降低了随后PT干预的参与率（RRR0.25，95%CI 0.13 - 0.50，p <0.001）。结论：感知的睡眠质量与第二天PT干预的参与率无关。然而，持续镇静输注、阿片类药物推注和谵妄，特别是在苯二氮卓类药物推注给药时发生，与后续PT干预呈负相关，是增加ICU PT干预参与的重要可改变因素。
Background: Poor sleep is common in the ICU setting and may represent a modifiable risk factor for patient participation in ICU-based physical therapy (PT) interventions. This study evaluates the association of perceived sleep quality, delirium, sedation, and other clinically important patient and ICU factors with participation in physical therapy (PT) interventions.Method: This was a secondary analysis of a prospective observational study of sleep in a single academic medical ICU (MICU). Perceived sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) and delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates included demographics, pre-hospitalization ambulation status, ICU admission diagnosis, daily mechanical ventilation status, and daily administration of benzodiazepines and opioids via bolus and continuous infusion. Associations with participation in PT interventions were assessed among patients eligible for PT using a multinomial Markov model with robust variance estimates.Results: Overall, 327 consecutive MICU patients completed >= 1 assessment of perceived sleep quality. After adjusting for all covariates, daily assessment of perceived sleep quality was not associated with transitioning to participate in PT the following day (relative risk ratio [RRR] 1.02, 95 % CI 0.96-1.07, p = 0.55). However, the following factors had significant negative associations with participating in subsequent PT interventions: delirium (RRR 0.58, 95 % CI 0.41-0.76, p < 0.001), opioid boluses (RRR 0.68, 95 % CI 0.47-0.99, p = 0.04), and continuous sedation infusions (RRR 0.58, 95 % CI 0.40-0.85, p = 0.01). Additionally, in patients with delirium, benzodiazepine boluses further reduced participation in subsequent PT interventions (RRR 0.25, 95 % CI 0.13-0.50, p < 0.001).Conclusions: Perceived sleep quality was not associated with participation in PT interventions the following day. However, continuous sedation infusions, opioid boluses, and delirium, particularly when occurring with administration of benzodiazepine boluses, were negatively associated with subsequent PT interventions and represent important modifiable factors for increasing participation in ICU-based PT interventions.