| Learning Objective #1: Discuss the importance of sleep in the ICU | |||
| Learning Objective #2: Discuss the use of EEG monitoring of sleep in children undergoing therapeutic paralysis and sedation |
Background and Significance to Nursing: Sleep is thought to be an active, restorative process, which in part is regulated by environmental cues and can be affected by medications and other disturbances. Sleep deprivation has been shown to impact the immune system, hormonal balance and other biological processes that promote healing. The goal of nursing care in the ICU is to enhance recovery and promote healing, yet a large aspect of the ability to recover and restore to health, obtaining sleep, is neglected in the ICU. Both patient report and other measurements of sleep have shown that sleep in the ICU is disrupted. Nurses usually observe when a patient is sleeping but in critically ill patients who are undergoing therapeutic paralysis (TP) and sedation normal observations of sleep are lost. Methods: Through electroencephalograph (EEG) monitoring and basic understanding of sleep waveforms the bedside nurse can assess when the patient is asleep vs. awake and can modify care so that a healing environment can be maintained. EEG monitoring is not routinely used in the ICU to assess sleep but this tool can be used effectively. In two children who were undergoing TP and sedation, bedside EEG monitoring with limited electrodes was used for assessment of sleep. Rapid eye movement sleep was not discernable due to TP, but non-rapid eye movement sleep was easily recognized. Sleep occurred through out the day and at time was fragmented. Use of EEG in an innovated way is possible at the bedside. Conclusion: When caring for critically ill children, bedside nurses can modify the environment and modify care (such as turning and vital sign acquisition) to promote longer periods of sleep. Bedside monitoring of EEG data to assess sleep in patients undergoing TP and sedation gives nurses a powerful tool to optimize care and the healing environment.
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