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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Optimizing sedation in the ICU: the eCASH concept

Abstract

Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept is a three-pronged approach to minimize sedation in ICU patients by ensuring adequate and timely analgesia is received; patient-centred care is encouraged, including communication aids, noise reduction to facilitate good sleep patterns, early mobilization, and family involvement; and, when needed, sedation is targeted to individual needs and regularly reassessed, with patients kept calm, comfortable and able to cooperate.

Key words: analgesia, communication, sleep, mobilization

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Humanizing critical care

Abstract

Sleep is important for human neurocognitive, emotional and physical health. Increasing evidence shows that the intensive care unit environment is disruptive to sleep patterns. Such disruption is unpleasant to patients, but mounting evidence suggests that it may also worsen outcome. However, improvements in the patient experience are readily obtained through simple measures such as the use of eyepads and earplugs. Early data suggest that such interventions are not only kind, but may impact on patient outcomes such as delirium rates.

Key words: sleep, light, noise, sound, eyepad, earplug

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The impact of changing work schedules on American firefighters’ sleep patterns and well-being

Abstract

Across the nation, fire departments are adopting the 48/96 work schedule, in which firefighters work 48 consecutive hours with the following 96 hours off. Our study objective was to explain and quantify the impact of switching from the Kelly schedule to the 48/96 schedule by measuring changes in sleep, feelings of daytime function, as well as perceptions of professional and personal well-being for American firefighters. Sleep diaries and self-reported surveys were administered to firefighters at an urban fire department. Sleep diaries measuring the number of hours slept and feelings of refreshment were compared one month before and four months after implementation of the 48/96 schedule. The self-reported surveys measured sleepiness levels via the Epworth Sleepiness Scale. Secondary study objectives included changes in professional and personal well-being time for personal schedules, satisfaction, and health habits before and after the 48/96 schedule was implemented. The 59 firefighters included in the study reported an increase in sleep on-shift after the new schedule implementation (5.8 to 6.6 hours/night, p < 0.001). Participants also reported increased feelings of refreshment on days off (p < 0.001) and decreased daytime sleepiness (p < 0.001). We also found a general trend of improved perceptions of satisfaction, less shift interference with personal schedules and decreased feelings of burnout. American firefighters appeared to benefit from a 48/96 schedule, with short-term improvements in sleep patterns, feelings of burnout, and time for personal schedules.

Key words: firefighters, shift-work sleep disorder, emergency medical technicians, workplace, sleep, fatigue, burnout, professional, organizational culture

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Insight into pathophysiology of sudden infant death syndrome

Abstract

Physiological studies that have been undertaken in children with apparent life-threatening events point to disturbances of the autonomic nervous system and brain stem abnormalities. These abnormalities are manifested as breathing dysfunctions and sleeping patterns, as well as heart rate variability. The diminished arousal response in infants who are exposed to intermittent hypoxia can be fatal during conditions when oxygen availability is limited. This inference well explains well the success of campaigns for supine sleeping position, which associated with the decrease in the rate of sudden infant
syndrome deaths.

Key words: apparent life-threatening event, sudden infant death syndrome, autonomic nervous system, sleep

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