Alyanna F.

Evangelista BSN-IV

Headphones In Intensive Care Unit Help Patients' Confusion And Sleep Patterns
Patients in an intensive care unit (ICU) often become confused or delirious soon after, or within a few days of admittance to the ICU. New research published in BioMed Central's open access journal Critical Care, shows that use of earplugs can result in better sleep (as reported by the patients), lower the incidence of confusion, and delay the onset of cognitive disturbances. Patients in the ICU are thought to suffer confusion and delirium due to sensory overload. Part of this is due to the physical injuries and sensations of the patients, and part due to their environment. Sound in the ICU has been a subject of research for several years. There is contestant noise due to equipment and people coming and going. However, patients complain that it is not so much the level of noise, but the interruptions, due to phones ringing and people talking, which is the most disturbing. Not surprisingly, studies have shown that the sleep of patients in ICU is severely fragmented with a corresponding lack of slow wave and REM sleep. While it is not practicable to have silent equipment (and patients need checking at regular intervals), researchers from the University of Antwerp and Antwerp University Hospital investigated the use of earplugs to reduce the amount of noise experienced by the patients as they slept. As a result of this simple solution, the researchers found that starting to use earplugs within the first 24 hours of entering ICU decreased the patient's risk for delirium or confusion by over 50%. They also noticed that patients sleeping with earplugs developed confusion and delirium later than patients without. After the first night, more of the patients with earplugs reported a better night's sleep. Prof Bart van Rompaey, who led this study, explained:

"The greatest improvement was observed in the risk of confusion, and seems to be strongest within the first 48 hours of admittance to the ICU. Delirium is a multifactorial process and, in our study, was also influenced by age, smoking, and severity of disease. Nevertheless the beneficial effect of earplugs in the ICU, especially in the first few days, clearly demonstrates the advantage of using them. Earplugs are a cheap and easy to use means of improving a patients sleep and preventing confusion."

Reference:
Rattue, P. (2012, May 4). "Headphones In Intensive Care Unit Help Patients' Confusion And Sleep Patterns." Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/245036.php.

Reaction:
In reaction to this, the area of intensive care unit (ICU) is a potentially hostile environment for the vulnerable critically ill patient. Frequently reported stressful environmental factors are noise, ambient light, restriction of mobility, and social isolation. Improving the ICU environment involves education of critical care staff, modification of equipment, and careful consideration to future ICU design. Despite to this, patients still perceive noise as a common cause of disrupted sleep on the ICU and may find it difficult to get to sleep because of the continuous background noise. It has been suggested that the disruption to sleep caused by noise may become more important as a patient begins to recover from critical illness. A suggestion from many studies that earplugs have been found to produce a significant decrease in REM latency and an increase in the percentage of REM sleep in healthy volunteers exposed to recorded ICU noise. Despite the lack of studies on ICU patients, this may be a possible option. However, staff must remember to remove earplugs from sedated or immobile patients at appropriate times, or they may worsen disorientation and confusion. Music has helped to decrease noise annoyance, heart rate, and systolic arterial pressure in cardiac patients and so this may be an option on the general ICU. Finally, noise cancellation devices have been shown to reduce the subjective assessment of noise in caregivers from an adult and pediatric ICU. Their use on patients may have similar problems as earplugs.