Does using pressure-controlled ventilation to rest respiratory muscles improve sleep in ICU patients?

Abstract

Sleep quantity and quality were significantly improved with PCV compared to low-PSV. Nocturnal respiratory muscles rest through PCV is recommended to improve sleep in ICU patients with acute-on-chronic respiratory failure.

A Meta-analysis of Sleep-promoting Interventions During Critical Illness

“…All of the 13 studies qualified as level I according to USPTF hierarchy of study design 23 . Eight trials looked at different modes of mechanical ventilations as sleep-promoting interventions, and the remaining five involved pharmacological, non-pharmacological, or environmental interventions 16,19,26–37 . For each of the 13 RCTs, patient characteristics, intervention, comparators, outcomes, and study design are provided in Table 1.…”

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Sleep fragmentation is higher during mechanical ventilation (vs no ventilation) (449) and NIV (vs no ventilation) (454). The proportion of time spent in stage N3 sleep is decreased in ventilated critically ill adults (0-27%) (438,439,448,449,453,462,464,(467)(468)(469)(470)(471)(472)(473), as is the proportion of time spent in REM stage sleep reduced (0-14%) (241,438,440,443,448,450,451,453,454,462,(464)(465)(466)(467)(468)(469)(470)(471)(472)(473). Sleep fragmentation index during mechanical ventilation ranges from 18 to 35 arousals and awakenings per hour of sleep (241,438,440,443,448,450,451,453,454,462,…”

“…Sleep fragmentation index during mechanical ventilation ranges from 18 to 35 arousals and awakenings per hour of sleep (241,438,440,443,448,450,451,453,454,462,(464)(465)(466)(467)(468)(469)(470)(471)(472)(473)(474). Respiratory-related arousals have been suspected to be a major factor involved in sleep fragmentation in critically ill adults, reported in one study as causing 19% (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) of arousal and awakenings from sleep (241,438,440,448,450,451,453,…”

Examining the Evidence to Guide Practice: Challenging Practice Habits

“…44,46,47,51,73 Studies that explored the relationship between sleep and ventilator mode showed that sleep was less fragmented with assist-control ventilation or pressure-controlled ventilation than in pressure support mode. [73][74][75] Nurses play a vital role in improving their patient's sleep and limiting sleep disruption. However, nurses can be limited by preconceived notions of what a sleeping patient looks like.…”

“…Reduce environmental noise (alarms, equipment, television, telephones, overhead pages, conversation) [43][44][45]51,64,67,69 Reduce light exposure during sleep time; dim lights 43,51,67 Provide patient and their family members with education about sleep promotion Consider ear plugs to reduce environmental noise 65,66 Regularly assess patients for delirium by using a valid and reliable tool 56 Promote a consistent sleep/wake cycle 53,56 Provide reorientation as needed 56 Provide hearing, vision, and communication tools as needed Implement nurse-driven early mobility protocols Assess for endotracheal tube discomfort 44 Limit dyssynchrony with the ventilator 44,75 Consider assist-control ventilation versus pressure support modes 73,74 Assess for medications that impair sleep: antipsychotics, β-blockers, proton pump inhibitors, H 2 blockers, antibiotics, antidepressants, corticosteroids, vasopressors, antiasthmatics, benzodiazepines, γ-aminobutyric acid agonists 45 Assess for medications that can cause withdrawal insomnia: sedatives, nicotine, alcohol, opiates 45 Ask the patient and/or family what the patient's regular sleep/wake cycle is to adapt care Promote consistent sleep and awake periods Encouraging activity helps with sleep hygiene 81 Limit use of sedatives when possible to promote improved sleep architecture 53,56,57 Limit the use of benzodiazepines 56,57 Assess the patient for signs of sleep deprivation and/or delirium 53,56,57 Use massage, music, acupressure, and/or aromatherapy to enhance relaxation 82,83 Assess the patient for sleep deprivation even if the patient appears to be sleeping (eg, eyes closed, vi...…”