Sleep monitoring by actigraphy in short-stay ICU patients.

Sleep deprivation is common in intensive care unit (ICU) patients. The criterion standard for sleep monitoring, polysomnography, is impractical in ICU. Actigraphy (a wrist watch indicating amount of sleep) proved to be a good alternative in non-ICU patients, but not in prolonged mechanically ventilated patients, probably due to ICU-acquired weakness. Short-stay ICU patients do not suffer from ICU-acquired weakness. However, the accuracy of actigraphy is unknown in these patients. Therefore, we compared actigraphy to polysomnography in short-stay ICU patients. Sleep measurements were conducted in 7 postcardiothoracic surgery patients. The sensitivity (percentage of actigraphy data that agreed with sleep determined using polysomnography) and specificity (percentage of actigraphy data that agreed with awake determined using polysomnography) were calculated. The result showed that actigraphy underestimated the amount of wake time and overestimated the amount of sleep. The median specificity for actigraphy was always less than 19% and sensitivity more than 94%. Therefore, actigraphy is not reliable for sleep monitoring in short-stay ICU patients.

Delirium in intensive care unit patients.

Delirium is defined as a disturbance of consciousness with cognitive changes or perceptual disturbances, which has developed over a short period of time, and is caused by a medical condition or a postsurgical state. Although historically dismissed as an inconvenient and transient problem, recent studies have reported that delirium is associated with more complications, increased length of hospital stay, and higher mortality. Although delirium is a prevalent condition after cardiothoracic surgery and in the intensive care unit (ICU), the condition appears to be largely underdiagnosed. Several detection tools have been developed for routine monitoring of delirium by nonpsychiatric personnel in the ICU, such as the Confusion Assessment Method for the Intensive Care Unit and the Intensive Care Delirium Screening Checklist. Management includes treatment of underlying disorders, nonpharmacological measures and symptomatic drug therapy. There is a need for well-designed randomized, double-blind, placebo-controlled trials on drug treatment.

[Delirium in the intensive care unit]. / Delirium op de intensive care.

Delirium is a common condition in the intensive care unit (ICU). Between 16-89% of all ICU patients experience an episode of delirium during admission. Several detection tools have been developed for use specifically in the ICU. The Confusion Assessment Method for the intensive care unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) combine high sensitivity with high specificity. Treatment consists of treatment of underlying disorders, nonpharmacological measures and symptomatic drug therapy. The prognosis for ICU patients who experience delirium is worse than for those who do not. Delirious patients are more likely to develop complications, spend longer in hospital and have a higher mortality rate. In view of the high frequency, poor prognosis, high costs and lack of studies into the treatment of ICU delirium, research into the possibilities for prevention, early detection and treatment of the condition is essential.