医学
谵妄
褪黑素
随机对照试验
重症监护医学
重症监护室
昼夜节律
心理干预
睡眠(系统调用)
重症监护
活动记录
内科学
精神科
计算机科学
操作系统
作者
Eugenia Y. Lee,M. Elizabeth Wilcox
出处
期刊:Current Opinion in Pulmonary Medicine
[Ovid Technologies (Wolters Kluwer)]
日期:2022-09-14
卷期号:28 (6): 515-521
被引量:3
标识
DOI:10.1097/mcp.0000000000000912
摘要
Sleep is particularly important for critically ill patients. Here, we review the latest evidence on how sleep and circadian disruption in the intensive care unit (ICU) affects physiology and clinical outcomes, as well as the most recent advances in sleep and circadian rhythm promoting interventions including therapeutics.On a molecular level, clock genes dysrhythmia and altered immunity are clearly linked, particularly in sepsis. Melatonin may also be associated with insulin sensitivity in ICU patients. Clinically, changes in sleep architecture are associated with delirium, and sleep-promoting interventions in the form of multifaceted care bundles may reduce its incidence. Regarding medications, one recent randomized controlled trial (RCT) on melatonin showed no difference in sleep quality or incidence of delirium.Further investigation is needed to establish the clinical relevance of sleep and circadian disruption in the ICU. For interventions, standardized protocols of sleep promotion bundles require validation by larger multicenter trials. Administratively, such protocols should be individualized to both organizational and independent patient needs. Incorporating pharmacotherapy such as melatonin and nocturnal dexmedetomidine requires further evaluation in large RCTs.
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