Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta-analysis.

BACKGROUND: Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications. AIM: To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients. STUDY DESIGN: This systematic review and component network meta-analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta-Analyses (PRISMA-NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk-of-bias tool (V.2.0) and the online Confidence in Network Meta-Analysis (CINeMA) application. RESULTS: Twenty-four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs. CONCLUSIONS: This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality. RELEVANCE TO CLINICAL PRACTICE: This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.

Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis.

AIM: The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit. BACKGROUND: Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited. DESIGN: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations. RESULTS: In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta-analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two-night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low. CONCLUSION: Massage intervention, particularly foot reflexology massage, with a two-night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non-invasive, low-cost and effective way to promote sleep quality in critically ill adult patients. RELEVANCE TO CLINICAL PRACTICE: Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients. STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution if such details are not necessary or do not apply to your work and state why.

Willingness of intensive care unit patients' family members to donate organs: A cross-sectional study.

The large gap between the demand for, and the supply of organs worldwide makes promoting organ donation an important global social issue. Even after someone has signed a consent form or registered for organ donation, ethically, the hospital still requires a family member's written permission before organ donation can proceed. As a result, a family member rather than the patient makes the final decision. This study investigated the willingness of the family members of hypothetical patients in intensive care units (ICUs) suffering from an irreversible condition to sign an organ donation consent form. A cross-sectional survey was conducted among family members of ICU patients recruited from one medical center in southern Taiwan from April to October 2014, which followed the STROBE guidelines. Of 110 ICU family members, 71 (64.5%) were willing to donate the organs of hypothetical patients with irreversible conditions. Based on logistic regression, family support, attitude, and knowledge of organ donation significantly predicted 34% of the variance in willingness to sign consent. Attitude toward organ donation and behavioral knowledge of organ donation correlated significantly with a willingness to sign a consent form. This study found that family support and organ donation attitudes were important factors in predicting the willingness to sign a consent form for the organ donation of hypothetical patients. The study provides evidence that nurses and healthcare staff need to consider family support and educate families on organ donation to encourage potential donors to accept and agree to organ donation.

Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta-analysis.

AIMS: To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases. REVIEW METHODS: Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through sub-group analysis while a meta-analysis was performed using the Review Manager 5.3 software. RESULTS: A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Sub-group analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [-0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]). CONCLUSION: The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients. IMPACT: Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients' sleep quality. STUDY REGISTRATION: The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185).

Readmission to the intensive care unit: an indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit.

PURPOSE: To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU). METHODS: The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003. RESULTS: Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 +/- 7.17 vs 5.22 +/- 4.95, P < 0.001) and were older and in a more severe condition than those not readmitted, but with a longer hospital stay and higher mortality rate (40% vs 3.6%, P < 0.001). A total of 26.4% of the readmission patients had an early readmission (<48 h), with a lower mortality rate than those with a late readmission (24.1% vs 45.7%, P = 0.049). A total of 46.4% of the patients were readmitted with the same diagnosis while the rest were readmitted with a new complication. Respiratory disease was the most common diagnosis for patients readmitted with a new complication (66.1%). The nonsurvivors had a significantly higher second Acute Physiology and Chronic Health Evaluation (APACHE II) score (22.1 +/- 8.8 vs.14.6 +/- 7.4, P < 0.001) and second Therapeutic Intervention Scoring System (TISS) score (30.1 +/- 8.7 vs 24.7 +/- 7.6, P = 0.001) and a longer stay in the first ICU admission (10.4 +/- 9 days vs 6.4 +/- 5 days, P = 0.010). A multivariate analysis showed that the first ICU length of stay and the APACHE II score at the time of readmission were the two risk factors for mortality. CONCLUSION: The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.

[Applying back massage protocol to promote an intensive care unit patient's quality of sleep].

This case report concerns the nursing experience of applying back massage to a patient in an intensive care unit (ICU) from 10 May, 2005, in order to improve the patient's quality of sleep. In order to collect information about his quality of sleep of the patient, the author used observation, interview and a Richards-Campbell sleep questionnaire (RCSQ). It was observed that, before massage, the patient's sleep quality was poor, which wa why the protocol with back massage was proposed. The results after back massage was applied that heart beat, respiration. oxygen saturation and blood pressure were not significantly improved. This was probably related to the patient's worry about having his endotracheal tube removed. The patient's perception of sleep, indeed, was obviously improved, a result which may have been related to his/her perception of comfort and care from the nurse. Applying back massage to an ICU patient may therefore be regarded as helpful improving the patient's sleep quality. It is hoped that this case report may serve as a positive reference for health care providers so that it may help patients to recover fully through rest and sleep. Since this report concerned only one patient, however, to understand the real outcome of how back massage could improve the quality of sleep of ICU patients, research is planned on the use of back massage protocol on a large number os such patients.