• Artificial intelligence
• Bedside implementation
• Deep learning
• ICU
• Machine learning
• Mechanical ventilation
• Patient-ventilator asynchrony
• Rule-based algorithms

• EMCLSH24018 Health~Holland

• blinds
• cardiac intensive care
• lighting
• room layout
• window features

• hospitalized patients
• management
• optimization
• review
• sleep

• Humans
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/etiology
• Hospitalization
• Health Personnel
• Male
• Female
• Inpatients
• Middle Aged

• Humans
• Ventilator Weaning/methods
• Critical Illness/therapy
• Intensive Care Units
• Randomized Controlled Trials as Topic
• Length of Stay/statistics & numerical data
• Hospital Mortality
• Respiration, Artificial/methods
• Interactive Ventilatory Support/methods
• Critical Care/methods

• automatic algorithms
• mechanical ventilators
• patient-ventilator asynchrony
• respiratory mechanics
• ventilator waveforms

• critical care
• dexmedetomidine
• melatonin
• multicomponent sleep bundle
• pharmacist
• sleep

• Humans
• Pharmacists/organization & administration
• Intensive Care Units/organization & administration
• Critical Illness/therapy
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/drug therapy
• Professional Role
• Pharmacy Service, Hospital/organization & administration
• Risk Factors
• Critical Care/methods
• Sleep/drug effects
• Sleep/physiology

• extubation
• mechanical ventilation
• scoping review
• sleep-weaning

• Arousal
• ICU
• Mechanically ventilated patients
• Noise-sensitivity
• Polysomnography
• Weaning

• Humans
• Polysomnography
• Male
• Ventilator Weaning
• Female
• Middle Aged
• Noise/adverse effects
• Aged
• Retrospective Studies
• Respiration, Artificial
• Adult
• Sleep Quality
• Arousal/physiology

• Airway extubation
• Endotracheal intubation
• Intensive care unit
• Rapid eye movement sleep, Polysomnography
• Sleep
• Ventilator weaning

• Humans
• Intensive Care Units/organization & administration
• Intensive Care Units/statistics & numerical data
• Male
• Female
• Middle Aged
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/physiopathology
• Sleep Wake Disorders/etiology
• Sleep Wake Disorders/epidemiology
• Aged
• Polysomnography/methods
• Respiration, Artificial/adverse effects
• Respiration, Artificial/methods
• Respiration, Artificial/statistics & numerical data
• Respiratory Insufficiency/therapy
• Respiratory Insufficiency/physiopathology
• Critical Illness/therapy

Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.

• Critical illness
• Critical care
• Sleep
• Sleep deprivation
• Polysomnography
• Melatonin

• circadian rhythm
• critical illness
• delirium
• research priority
• sleep deficiency

• Humans
• United States
• Sleep
• Polysomnography
• Societies, Medical

• K23 HL140482 NHLBI NIH HHS
• K23 HL138229 NHLBI NIH HHS
• C06 OD028307 NIH HHS
• P01 AG011412 NIA NIH HHS
• U01 OH012072 NIOSH CDC HHS
• OT2 HL158287 NHLBI NIH HHS
• R01 HL140580 NHLBI NIH HHS
• T32 HL007778 NHLBI NIH HHS
• K99 NR019862 NINR NIH HHS
• K76 AG059936 NIA NIH HHS
• R25 HL126140 NHLBI NIH HHS
• OT2 HL156812 NHLBI NIH HHS
• UL1 TR001863 NCATS NIH HHS
• OT2 HL161847 NHLBI NIH HHS
• American Thoracic Society

• After Hospitalisation
• Critically Ill Patients
• Prevalence
• Sleep Disturbances

• Humans
• Patients
• Anesthesia/adverse effects
• Hospitalization
• Pain
• Sleep/physiology

• Patient-ventilatory synchrony
• Proportional assist ventilation
• Ventilator-free days
• Weaning from mechanical ventilation
• Work of breathing

• Humans
• Respiration, Artificial/adverse effects
• Respiration, Artificial/methods
• Interactive Ventilatory Support/adverse effects
• Ventilator Weaning/methods
• Positive-Pressure Respiration/methods
• Respiration
• Randomized Controlled Trials as Topic
• Multicenter Studies as Topic

• IPR - 136755 CIHR
• PJT - 162086 CIHR
• Canadian Institutes of Health Research

• copd
• covid-19
• dexmedetomidine
• niv compliance
• oxygenation
• rass score
• sedation in icu

• acute respiratory failure
• intensive care unit
• non-invasive ventilation
• sleep

• Critical care
• Intensive care unit
• Sleep

• acute respiratory failure
• asynchrony index
• conventional mechanical ventilation
• neurally adjusted ventilatory assist
• patient-ventilator asynchrony

• Extracorporeal membrane oxygenation
• Mechanical ventilation
• Myotrauma
• Respiratory failure
• Ventilator-induced lung injury

The sleep architecture of critically ill patients being treated in Intensive Care Units (ICU) and High Dependency Units (HDU) is frequently unsettled and inadequate both qualitatively and quantitatively. The study aimed to investigate and elucidate factors influencing sleep architecture and quality in ICU and HDU in a limited resource setting with financial constraints, lacking human resources and technology for routine monitoring of noise, light and sleep promotion strategies in ICU.

The study was longitudinal, prospective, hospital-based, analytic, and observational. Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) pre hospitalisation scores were recorded. Patients underwent 24-hour polysomnography (PSG) with the simultaneous monitoring of noise and light in their environments. Patients stabilised in ICU were transferred to HDU, where the 24-hour PSG with the simultaneous monitoring of noise and light in their environments was repeated. Following PSG, the Richards-Campbell Sleep Questionnaire (RCSQ) was employed to rate patients’ sleep in both the ICU and HDU.

Of 46 screened patients, 26 patients were treated in the ICU and then transferred to the HDU. The mean (SD) of the study population’s mean (SD) age was 35.96 (11.6) years with a predominantly male population (53.2% (n=14)). The mean (SD) of the ISI and ESS scores were 6.88 (2.58) and 4.92 (1.99), respectively. The comparative analysis of PSG data recording from the ICU and HDU showed a statistically significant reduction in N1, N2 and an increase in N3 stages of sleep (p<0.05). Mean (SD) of RCSQ in the ICU and the HDU were 54.65 (7.70) and 60.19 (10.85) (p-value = 0.04) respectively. The disease severity (APACHE II) has a weak correlation with the arousal index but failed to reach statistical significance (coeff= 0.347, p= 0.083).

Sleep in ICU is disturbed and persisting during the recovery period in critically ill. However, during recovery, sleep architecture shows signs of restoration.

• polysomnography
• sleep deprivation
• sleep disorders
• sleep stages

• Adaptive support ventilation
• Mechanical ventilation
• Neurally adjusted ventilatory assist
• Pressure support ventilation
• Proportional assist ventilation
• Weaning

• Evidence-based medicine
• GRADE
• Guidelines
• Sepsis
• Septic shock
• Systematic review

• asynchronies
• breathing pattern
• delirium
• intensive care outcomes
• lung–brain crosstalk
• mechanical ventilation
• respiration

Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear.

We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed.

Seven studies (n = 693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.93; 95% CI 1.12 to 3.32; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = − 2.63; 95% CI − 4.22 to − 1.03; P = 0.001) and hospital mortality (OR = 0.58; 95% CI 0.40 to 0.84; P = 0.004) and prolongs ventilator-free days (MD = 3.48; 95% CI 0.97 to 6.00; P = 0.007) when compared with other modes.

Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.

The online version contains supplementary material available at 10.1186/s13054-021-03644-z.

• Mechanical ventilation
• Neurally adjusted ventilatory assist
• Patient–ventilator asynchrony
• Weaning success

• ICU
• circadian rhythms
• sleep disorders

Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others.

Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23).

Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation.

The online version contains supplementary material available at 10.1186/s13613-021-00863-z.

• Airway extubation
• Intensive care unit
• Mechanical ventilation
• Sleep
• Ventilator weaning

Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.

• Brain injury
• Critical illness
• Intensive care unit
• Sleep
• Sleep deprivation

• GRADE
• evidence‐based medicine
• guidelines
• sepsis
• septic shock
• systematic review