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Published on: August 19, 2020
Sleep Health in Critically Ill Children With Acute Respiratory Failure
Laura Beth Kalvas1, Onella S Dawkins-Henry2, Monica R Ordway3
1Laura Beth Kalvas is Nurse Scientist, Nationwide Children's Hospital Center for Nursing Excellence, Near East Office Building, 431 S 18th St, Columbus, Ohio 43205 (laurabeth.kalvas@nationwidechildrens.org); Adjunct Assistant Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; and Affiliate Faculty, The Ohio State University College of Nursing, Columbus, Ohio.
Insights
Children in the pediatric intensive care unit (PICU) experience significantly disrupted sleep health, impacting their recovery. Nurse-led interventions are needed to improve sleep in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Sleep science
- Child development
Background:
- Sleep health is crucial for children's overall health and development.
- Poor sleep can negatively affect recovery during critical illness.
Purpose of the Study:
- To investigate sleep health in critically ill children within the pediatric intensive care unit (PICU).
- To compare sleep health between children receiving usual care and those in a nurse-led chronotherapeutic care bundle intervention.
Main Methods:
- Secondary analysis of the RESTORE Resilience (R2) trial data.
- Comparison of parent-reported baseline sleep health with PICU sleep health using actigraphy and behavioral observations.
- Assessment of compliance with baseline sleep behaviors and alertness levels.
Main Results:
- 45% of participants had atypical baseline sleep health.
- Critically ill children exhibited irregular sleep patterns, significant sedation (≥25% of days), and fragmented sleep.
- Little association was found between baseline and PICU sleep health, or between the intervention and PICU sleep outcomes.
Conclusions:
- Critically ill children demonstrate profoundly disrupted sleep health in the PICU.
- Findings highlight the need for targeted, nurse-led interventions to promote better sleep in this vulnerable population.
Background:
Sleep health is an overlooked but important part of children's health and development. The health consequences associated with poor sleep health may impact recovery during critical illness.
Objective:
Explore sleep health among children in the pediatric intensive care unit (PICU) receiving usual care or a nurse-led chronotherapeutic care bundle.
Methods:
Secondary analysis of the RESTORE Resilience (R2) trial. Parent-reported baseline sleep health was compared with PICU sleep health, including compliance with baseline sleep behaviors, alertness levels, and actigraphy-based measures of sleep timing, efficiency, and duration.
Results:
In 52 R2 participants (6 months to 17 years), 49 provided prehospital sleep data and 22/49 (45%) had atypical baseline sleep health. Participants had irregular PICU sleep behaviors and spent ≥ 25% of PICU days sedated. Children experienced little daytime activity consolidation and short, fragmented sleep episodes. Total sleep time was within 1 hour of baseline on 23 (11%) study days. There were few associations between baseline and PICU sleep health or between R2 bundle implementation and PICU sleep health.
Conclusions:
Critically ill children demonstrated disrupted sleep health. Results will inform nurse-led interventions to promote sleep in the PICU.
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