Does using pressure-controlled ventilation to rest respiratory muscles improve sleep in ICU patients?

Sleep is commonly altered in critically ill patients. Ventilatory mode may impact on quality of sleep. The aim of our study was to evaluate the effect on sleep of pressure-controlled ventilation (PCV) to spontaneous ventilation with 6 cm H2O inspiratory pressure (low-PSV).

Thirty-five patients intubated and mechanically ventilated for acute-on-chronic respiratory failure were included in this prospective randomized cross-over study. Nine were discarded, 13 received PCV first (10 p.m.-2 a.m.) and then low-PSV (2-6 a.m.) and 13 patients received low-PSV first and then PCV.

Sleep architecture was altered (50.4% of the night was spent in wakefulness). PCV was associated with significantly improved sleep quality and quantity compared to low-PSV: sleep efficiency (total sleep time/total recording time) was 63% (range: 9-100) vs. 37% (0-96; p = 0.0002), stage 2 NREM sleep was 33% vs. 13% (p = 0.0005), stages 3 and 4 NREM sleep were 9% vs. 3.5% (p = 0.003) and REM sleep was 6.5% vs. 0% (p = 0.003).

Sleep quantity and quality were significantly improved with PCV compared to low-PSV. Nocturnal respiratory muscles rest through PCV is recommended to improve sleep in ICU patients with acute-on-chronic respiratory failure.