Browsing by Subject "critical care"

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    Exploring the Effects of the Presence or Absence of Sleep Architecture and Critically Ill Patient Outcomes
    (2019-05) Genzler, Laura
    Abstract Background: Sleep disturbances and deprivation are known to exist in the critically ill patient. Over a 24-hour period, the critically ill can have 7-9 hours of sleep, but as much as 50% of that sleep can occur during daytime hours, signifying significant sleep fragmentation. Furthermore, some critically ill patients have been found to have abnormal brain waves that obliterate normal sleep architecture. These patients are without conventional sleep markers exhibiting no Stage II sleep spindles, minimal rapid eye movement sleep, and slow background brain wave reactivity. Disrupted sleep has been associated with delirium, weakened immune system, impaired wound healing, nitrogen imbalance, and negative cardiac, pulmonary, and neurological consequences which may all lead to negative patient outcomes. Objective: The objective of this dissertation was to explore factors and outcomes associated with sleep disturbances in critically ill patients. The state of knowledge related to sleep and delirium in critically ill patients were explored. The tools and challenges of measuring sleep in patients while in the intensive care unit (ICU) were also explored. Methods: Using a data base from retrospective chart review of 84 subjects, factors and outcomes related to the presence or absence of sleep in critically ill patients were explored. Literature reviews determined the state of knowledge related to sleep and delirium and the measurement of sleep in critically ill patients. Results. Severity of disease was significantly associated the absence of sleep architecture in both the continuous electroencephalogram (cEEG) 1 to 2- and 1 to 5-day groups. Propofol was significantly associated with the presence or absence of sleep architecture in the day 1-2 group. After adjusting for age and medications, serum creatinine and neurologic physiologic state during days 1 to 2 of cEEG are factors associated with no sleep architecture using bi-variate analysis. Multivariate logistic regression adjusting for age and medications during Days 1-2 cEEG found abnormal serum creatinine to be statically significant. After adjusting for age and medications, encephalopathy and developmental disability were factors significantly associated with no sleep architecture in the Day 1-5 group. . Multivariate logistic regression adjusting for age and medication during days 1-5 cEEG found the physiologic states of encephalopathy and developmental disability to be significantly associated with the absence of sleep architecture. The patient outcomes of increased mechanical ventilation days, ICU length of stay and hospital length of stay were associated significantly with no sleep architecture during Days 1-2 cEEG. In the 1-5 Days cEEG group, hospital length of stay was significantly associated with no sleep architecture. Post-hospitalization transfer location was associated with no sleep architecture for both cEEG groups. Discharge to home was associated with the presence of sleep architecture. Conclusions: Certain patient characteristics are associated with the presence or absence of sleep architecture. The presence or absence of sleep architecture may impact patient outcomes. The exploratory study indicates that future prospective research with larger sample sizes and sleep architecture specifics is needed to advance the state of knowledge. While delirium theoretically may be related to sleep disturbances, more research is needed to determine if a correlation exists. Measuring sleep architecture in ICU patients can be challenging. Critical illness can impact the reliability and accuracy of sleep measurement tools including the gold standard polysomnography. Researchers need to be clear in their research goals and know the challenges related to the various sleep measurement tools.
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    Family Stress in Long-Term Pediatric Critical Care: A Mixed Methods Study
    (2015-08) Hagstrom, Sandra
    Hospitalization in the pediatric intensive care unit (PICU) is stressful for families and disruptive for their normal lives. As new technology has become available, the number of children requiring prolonged stays in the PICU has increased. This mixed methods study explored stress in families whose children were hospitalized in the PICU for more than one week, collecting data one to two weeks after admission, then four to five weeks later. The purpose was to describe sources of stress for families whose children require extended hospitalization in the PICU and explore how sources of stress change over time. Data collection included semi-structured interviews and completion of the Family Inventory of Life Events (McCubbin, Thompson & McCubbin, 1996) and Family System Stressor Strength Inventory (Berkey & Hanson, 1991) at each time point. Nine parents of eight children participated in the first phase of data collection; two mothers participated in the second phase. Data analysis revealed the following themes related to Aim 1 (sources of stress): separation, not knowing, child’s illness and distress, care and caring, emotional stress, physical stress, job and financial stress, and what we’ve been through before. Themes related to Aim 2 (change over time) were: stress builds, and stress decreases as the unknowns become known. Analysis of Time 2 data revealed similarities in sources of stress compared to Time 1, but there was a shift in the relative priority and contribution that each stressor made to the overall perception of stress as hospitalization became prolonged and the child’s condition improved; participants reported aspects of care and caring as most important at this point. A new subtheme in the original care and caring theme was also identified: considering the child’s entire picture. Findings demonstrated sources of stress directly related to the child’s acute illness as well as stress resulting from the child’s hospitalization and ongoing healthcare needs, all of which contributed to the perception of family stress. Over time, stress was compounded and there was a shift from the primary stressors of unknowns and separation of the family to stressors related to the care and caring provided by the team.