Do earplugs stop noise from driving critical care patients into delirium?

Quality sleep is a problem for the critically ill who are cared for in an environment where interventions night and day are common, staff members are constantly present in relatively high numbers, and treatment is accompanied by a range of changing warning tones and alarms and lights. These critical care units are generally designed without a focus on patient comfort, sleep, and rest and often lack access to appropriate natural daylight. To add to this problem, critical illness, particularly sepsis, disrupts circadian rhythms and sleep patterns, and disruption of circadian rhythms, in turn, impairs immunity and contributes to delirium. In a randomized controlled trial in the previous issue of Critical Care, Van Rompaey and colleagues have intervened to reduce noise, which is a key factor in this disruption, by having patients use earplugs at night. Delirium was assessed by using the NEECHAM (Neelon and Champagne) confusion scale, and sleep perception was assessed by patients' responses to a set of five questions. After the first night, patients reported a better sleep perception and the occurrence of delirium was reduced (hazard ratio of 0.47 for the development of delirium) or was delayed. The study did not quantify adequacy of pain control in post-surgical patients and used patient reporting to assess sleep. Whether patients were receiving respiratory or other organ support was not reported. The potential benefit of earplugs is an important practical finding that could be implemented in most intensive care units.