SUMMARY
J. OTO, K. YAMAMOTO, S. KOIKE, H. IMANAKA§, M. NISHIMURA
Daily sedative interruption (DSI) may reduce excessive
sedation and shorten the duration of mechanical ventilation. It is not clear,
however, how DSI affects sleep characteristics. For patients receiving
mechanicalventilation, we compared the effect on sleep quality of DSI and
continuous sedation (CS). Twenty-two mechanically ventilated patients who were
receiving midazolam by infusion were randomly assigned to two groups, DSI
(n=11) or CS (n=11). In the DSI group, sedatives were interrupted until the
patients awoke and expressed discomfort, after which midazolam or opioids were
administered intermittently as needed during the daytime (0600 to 2100 hours);
during the night (2100 to 0600) midazolam was administered intravenouslyto
maintain Ramsay sedation scale 4 to 5. In the CS group, the sedatives were
titrated to obtain Ramsay sedation scale 4 to 5 throughout the day. The
polysomnography of each patient was recorded continuously over a 24 hour period.
Sleep stages were analysed using Rechtschaffen and Kales criteria. In the DSI
group, the amount of stage 3 and 4 non-rapid eye movement sleep (slow wave
sleep) was longer (6 vs 0 minutes, P=0.04) and rapid eye movement sleep was
longer than in CS (54 vs 0 minutes, P=0.02). In the CS group, total sleep time
during night-time was longer (8.7 vs 7.3 hours, P=0.047) and frequency of
arousal was lower (2.2 vs 4.4 event/hour, P=0.03) than those in the DSI group.
All mechanically ventilated patients demonstrated abnormal sleep architecture,
but, compared with CS, DSI increased the amount of slow wave sleep and rapid
eye movement sleep.
(Anaesth Intensive Care 2011; 39: 392-400)
Full Text: CLICK HERE
No comments:
Post a Comment