Patient-related factors may influence nursing perception of sleep in the Intensive Care Unit.

OBJECTIVE: There exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep. METHODS: Patients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done. RESULTS: 38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men. CONCLUSION: The results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU.

Pneumonia and disseminated bacteremia with Pasteurella multocida in the immune competent host: A case report and a review of the literature.

Pasteurella multocida is primarily an opportunistic infection, most commonly of skin and soft tissue following animal bites particularly in the elderly and immunocompromised. While invasive disease with P. multocida has been documented in patients at high risk, such as those with organ transplants, malignancy, and cirrhosis, infections other than cellulitis associated with this pathogen are exceedingly rare in the immunocompetent population. We report a 70 year old Caucasian female with occurrence of a P. multocida pneumonia and resultant bacteremia in an immunocompetent host. Similar to prior case studies, the patient presented with a history of having significant exposure to animals at her residence. We undertook a review of the literature for reports of disseminated P. multocida in immunocompotent hosts in the absence of the typical presentation of cellulitis. Literature has suggested the possibility of nasal and oropharyngeal colonization of patients with frequent interactions with domestic animals, in whom periods of suppressed immune function may lead to activation of infection. P. multocida is commonly susceptible to most beta-lactams, including those utilized for the treatment of community acquired pneumonia. The utilization of macrolides should be avoided in these patients as susceptibilities are unpredictable, however fluoroquinolones maintain activity and may be an alternative therapy.