The Construction And Empirical Study Of Sleep Care Bundle To Prevent ICU Delirium

Objective To construct a evidence-based sleep care bundle and investigate the effects on sleep and ICU delirium,so as to provide reference for clinical work.Methods1 Systematically searched the available evidence of sleep interventions on preventing delirium in intensive care units and summarized the best available evidence.2 A Delphi method was used to construct the items included in SLEEP-MAD bundle.3 This was a quasi-experimental study.Participants were selected from the ICU in a tertiary comprehensive hospital in Shenzhen.From September2019 to November 2019,subjects were included as control group,which received routine care and ABCDEF bundle.From December 2019 to January2020,subjects were included as the intervention group,which received SLEEP-MAD bundle on the basis of the control group.The results about sleep,delirium,prognosis,environment and the compliance of ICU medical staff in implementing ABCDEF bundle were compared between the two groups.the compliance of SLEEP-MAD bundle were compared between each months.Results1 A total of 22 articles were included,including 4 guidelines,2 systematic reviews,14 randomized controlled studies and 2 quasi-experimental studies.The best evidence included establishing a sleep protocol,controlling light,providing earplugs and eye patch,reducing environmental noise,providing nonpharmacologic sleep promotion methods,choosing appropriate sleep aids medication,encouraging daytime activity,and maintaining a normal circadian rhythm,totaling 27 items.2 Response rate of two rounds of Delphi consultation was 100%,respectively.Experts' authority coefficient was 0.87 and the coefficients of concordance were 0.300,0.336 for two levels of indicator,respectively.The final multicomponent sleep intervention program: SLEEP-MAD bundle,consisted of 8 first-level indicators,and 27 second-level indicators.3 Totally 92 patients were included during the control period(57 patients)and intervention period(35 patients).Affected by COVID-19 the actual intervention period is from December 2019 to January 25,2020.Compared with the control group(n=57),we found that the scores of the Richards-Campbell sleep scale in the intervention group(n=35)was significantly higher(68.45±11.14 vs 57.24±13.76,P< 0.01).As for the sleep time of the patients observed by the nurses(5.3±5.67 vs 4.16±1.26,h),the intervention group was longer.We detected that the incidence of delirium was14.3% in the intervention group and 24.6% in the control group,with no statistically difference(P> 0.05),but in mechanically ventilated patients the incidence of delirium in the intervention group was lower(12.0% vs 34.2%,P<0.05).There was no statistically difference between the duration of delirium and the days of no delirium/coma between the two groups(P> 0.05).Compared the secondary outcomes,in the intervention group,the pain score was lower and the total dose of dexmedetomidine was more than the control group,with statistically difference(P< 0.05).In the intervention group,the night light and noise was lower than the control group,with significant difference(P< 0.01).No statistically differences were noted in ICU cost,duration of mechanical ventilation,length of ICU stay,and mortality.The compliance of medical staff in implementing ABCDEF bundle,the intervention group and the control group were 74.0%,72.5% respectively,with no statistically difference(P>0.05).The compliance rate of the SLEEP-MAD bundle in the intervention group increased from 75.3% 1st month to 78.7%2nd months after the intervention,with statistically difference(P<0.05).Conclusions Based on the best evidence summary and Delphi method,this study constructed the ICU sleep care bundle(SLEEP-MAD bundle).Clinical empirical study found that on the base of ABCDEF bundle,SLEEP-MAD bundle could improve the sleep quality and prolong the sleep time of ICU patients.Effectively reduce the incidence of ICU delirium in mechanically ventilated patients.The bundles implemented by a multidisciplinary team and the compliance was supervised.The compliance of medical staff was continuously improved in implementing bundles.