UCSF

Delirium and sleep deprivation are experienced by patients in intensive care units (ICUs) and have been associated with negative patient outcomes. Benzodiazepine, often used for sedation in critically ill patients, contributes to an imbalance of neurotransmitters that can influence the wake-sleep-regulatory system and the occurrence of delirium. This dissertation evaluated the effect of a sedation wake-up trial (SWT) and spontaneous breathing trial (SBT) on the occurrence of delirium, perception of sleep and other outcomes in trauma ICU (TICU) patients.

The first study was a prospective interventional trial that implemented the SWT plus SBT in TICU patients. The intervention group (IG, n = 20) experienced less delirium (OR 0.107; 95% CI: 0.025-0.459), recovered from drug-induced coma faster (RH 2.25; 95% CI: 1.08-4.65), and was liberated from the mechanical ventilator (RH 3.09; 95% CI: 1.45-6.60) and discharged from the TICU sooner (RH 4.20; 95% CI: 1.82-9.69) than the control group (CG, n = 20). Sleep perception was rated as bad and did not differ between groups.

A second report addressed the feasibility of conducting the SWT plus SBT based on the ability to implement the combined intervention, measure patients' physiological responses, and maintain patient safety. IG patients passed 67% of the 39 SWTs performed. Those who did not pass presented RASS scores of +1 and +2, tachycardia, or showed ventilator asynchrony. Eighteen patients tolerated their first SBT and after the second SBT more than half of patients were discontinued from the mechanical ventilator. Physiological responses (i.e., heart rate, respiratory rate, and systolic blood pressure) increased significantly from the beginning to the end of the SWT. However, their overall means did not increase by 20%. Opioids were not interrupted during the SWT; however, at the end of six SWTs patients reported having pain.

The findings demonstrated that those TICU patients who received the combined intervention decreased in the occurrence of delirium and improved in several outcomes. However, this conclusion is limited by the non randomized design, the small sample, and the lack of control in the type of sedative given to both groups. The combined intervention was well tolerated, safe, and clinically feasible.