0780 Effect Of A Sleep/Circadian Friendly Protocol On The Outcomes Of Patients Admitted To The Medical Intensive Care Unit: A Randomized Control Trial. (27th May 2020) - Wakefield, C
Abstract: Introduction: Critically ill patients often suffer from fragmented sleep due to light and noise in the intensive care unit (ICU). We investigated whether placing patients in a sleep/circadian friendly protocol improved patient-reported sleep quality and ICU outcomes. Methods: Patients were included if they were expected to have a >24-hour stay. Exclusion criteria included age <18 years, pregnancy, frequent overnight assessments, poor prognosis, pre-existing cognitive impairment, and severe psychological disorders. Patients were randomized to a sleep/circadian protocol or control protocol. Demographic, treatment, sound (dB), light (lux), patient-reported sleep, and medical outcomes were collected. Those who were not maintained in the sleep/circadian protocol were combined with the controls for statistical analysis. Univariate analysis was performed with Chi-Square test and Wilcoxon rank-sum test. Results: Sixty-one patients were enrolled: 28 randomized to sleep/circadian protocol, 33 to control protocol. 14 subjects were excluded from analysis due to developing criteria for exclusion. Nine patients (median age 50 years, 6 females) maintained in the sleep/circadian protocol, 13 patients were not maintained in sleep/circadian protocol and 25 patients in control protocol (median age 64 years, 20 females). There was no difference in age, gender, or race between groups ( p > 0.05). Median ICU first overnight dB level (10:00pm-6:00am) was 44.2 (±2.7) for sleep/circadian protocol and 50.5 (±4.9) for combined group (p= 0.008). Median ICU first overnight lux (10:00pm-4:00am) was 2.28 (±61.3) in sleep/circadian protocol and 18.42 (±90.9) in combined group (p=0.0374). A continued stay in the sleep/circadian protocol resulted in decreased total decibel level ( p = 0.0018) decreased total overnight lux exposure ( p = 0.0025) and decreased reported awakenings in first night ( p= 0.0175). There were no differences in ICU length of stay, inpatient mortality, or readmission rates between groups ( p >0.05). Three patients developed delirium, all originally randomized to control group. Conclusion: We report on the successful outcomes associated with a sleep/circadian friendly protocol within a large tertiary center medical ICU which resulted in significant decreases in objectively assessed noise and light, and subjectively reported nocturnal awakenings. We continue to collect data to determine if the sleep/circadian friendly protocol should be permanently implemented in the ICU. Support: None.