The association of sleep quality, delirium, and sedation status with daily participation in physical therapy in the ICU

• Type of Material: Article
• Authors: Biren B. Kamdar, University of California Los Angeles; Michael P. Combs, University of California Los Angeles; Elizabeth Colantuoni, Johns Hopkins University; Lauren M. King, York Hospital; Timothy Niessen, Johns Hopkins University; Karin J. Neufeld, Johns Hopkins University; Nancy Collop, Emory University; Dale M. Needham, Johns Hopkins University
• Language: English
• Date: 2016-08-18
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s). 2016
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13054-016-1433-z
• Title of Journal or Parent Work: Critical Care Nursing Quarterly
• ISSN: 0887-9303
• Volume: 20
• Issue: 1
• Start Page: 261
• End Page: 261
• Grant/Funding Information: Dr. Kamdar is currently supported by a Career Development Award from the University of California, Los Angeles (UCLA) Clinical and Translational Science Institute (CTSI) [National Institutes of Health (NIH)/National Center for Advanced Translational Science (NCATS) UCLA UL1TR000124]; during this project, was supported by a Ruth L. Kirschstein National Research Service Award (NRSA) from the National Institutes of Health (F32 HL104901).
• Keywords: INTENSIVE-CARE-UNIT; ACUTE RESPIRATORY-FAILURE; CRITICALLY-ILL PATIENTS; Critical Care Medicine; IMPROVEMENT PROJECT; MECHANICALLY VENTILATED PATIENTS; Delirium; Rehabilitation; POINT-PREVALENCE; OLDER-ADULTS; Intensive care unit; EARLY MOBILIZATION; Life Sciences & Biomedicine; Early ambulation; CRITICAL ILLNESS; General & Internal Medicine; Sedation; Science & Technology; ACUTE LUNG INJURY; Sleep
• Research Categories: Biology, Biostatistics; Health Sciences, Rehabilitation and Therapy; Health Sciences, Health Care Management

Abstract

Background: Poor sleep is common in the ICU setting and may represent a modifiable risk factor for patient participation in ICU-based physical therapy (PT) interventions. This study evaluates the association of perceived sleep quality, delirium, sedation, and other clinically important patient and ICU factors with participation in physical therapy (PT) interventions. Method: This was a secondary analysis of a prospective observational study of sleep in a single academic medical ICU (MICU). Perceived sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) and delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates included demographics, pre-hospitalization ambulation status, ICU admission diagnosis, daily mechanical ventilation status, and daily administration of benzodiazepines and opioids via bolus and continuous infusion. Associations with participation in PT interventions were assessed among patients eligible for PT using a multinomial Markov model with robust variance estimates. Results: Overall, 327 consecutive MICU patients completed ≥1 assessment of perceived sleep quality. After adjusting for all covariates, daily assessment of perceived sleep quality was not associated with transitioning to participate in PT the following day (relative risk ratio [RRR] 1.02, 95 % CI 0.96-1.07, p = 0.55). However, the following factors had significant negative associations with participating in subsequent PT interventions: delirium (RRR 0.58, 95 % CI 0.41-0.76, p <0.001), opioid boluses (RRR 0.68, 95 % CI 0.47-0.99, p = 0.04), and continuous sedation infusions (RRR 0.58, 95 % CI 0.40-0.85, p = 0.01). Additionally, in patients with delirium, benzodiazepine boluses further reduced participation in subsequent PT interventions (RRR 0.25, 95 % CI 0.13-0.50, p <0.001). Conclusions: Perceived sleep quality was not associated with participation in PT interventions the following day. However, continuous sedation infusions, opioid boluses, and delirium, particularly when occurring with administration of benzodiazepine boluses, were negatively associated with subsequent PT interventions and represent important modifiable factors for increasing participation in ICU-based PT interventions.