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Background: Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS)., Objectives: The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes., Methods: We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression., Results: Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P < .001) and longer length of mechanical ventilation (β = 0.420, P = .028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P < .001)., Discussion: Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.

Background: Older adults in the intensive care unit (ICU) often experience sleep disturbances, which may stem from life-threatening illness, the ICU environment, medications/sedation, or psychological stress. Two complementary endocrinological responses occur as a result of compromised sleep and consequently could exacerbate ICU-acquired weakness: a decrease in anabolic hormones leading to decreased protein synthesis and an increase in catabolic hormones leading to increased protein degradation. Age-associated decreases in anabolic hormones, such as insulin-like growth factor 1, testosterone, and growth hormone, may inhibit protein synthesis. Likewise, age-associated increases in insulin resistance, glucocorticoids, and myostatin can stimulate muscle atrophy and further reduce protein synthesis. Thus, perhaps, sleep promotion in the ICU may attenuate muscle atrophy among critically ill older adults who are at risk for ICU-acquired weakness and subsequent functional decline., Objectives: The aim of this study was to discuss the hypothesized theoretical underpinnings of the relationship between sleep disturbances and ICU-acquired weakness among critically ill older adults., Methods: A search of research literature published from 1970 to 2018 and indexed in MEDLINE, Embase, CINAHL, and Ovid was undertaken, and relevant sources were selected to build an informed discussion., Results: Nurses must be mindful of secondary sleep disturbances that occur throughout the acute phase of critical illness and their probable links to ICU-acquired weakness. Targeted interventions to promote functional outcomes in elderly patients should consider this relationship., Discussion: Improved sleep may have the potential to decrease the severity of muscle atrophy and ICU-acquired weakness. Future research must explore this hypothesis and the underlying mechanisms of the association between sleep disturbances and ICU-acquired weakness in critically ill older adults.

Objectives: Explore the effect of an automated reorientation intervention on ICU delirium in a prospective randomized controlled trial., Background: Delirium is common in ICU patients, and negatively affects outcomes. Few prevention strategies have been tested., Methods: Thirty ICU patients were randomized to 3 groups. Ten received hourly recorded messages in a family member's voice during waking hours over 3 ICU days, 10 received the same messages in a non-family voice, and 10 (control) did not receive any automated reorientation messages. The primary outcome was delirium free days during the intervention period (evaluated by CAM-ICU). Groups were compared by Fisher's Exact Test., Results: The family voice group had more delirium free days than the non-family voice group, and significantly more delirium free days (p = 0.0437) than the control group., Conclusions: Reorientation through automated, scripted messages reduced incidence of delirium. Using identical scripted messages, family voice was more effective than non-family voice., (Copyright © 2017 Elsevier Inc. All rights reserved.)