• Critical care
• Critical illness
• Family caregivers
• Hospitalisation
• Needs assessment
• Psychological distress

• Humans
• Caregivers/psychology
• Male
• Female
• Qualitative Research
• Middle Aged
• Critical Care/psychology
• Adult
• Anxiety/psychology
• Social Support
• Interviews as Topic
• Intensive Care Units
• Aged
• Family/psychology
• Needs Assessment

• IK2 HX003530 HSRD VA
• IK6 HX003399 HSRD VA

• Analgesia
• Critically ill
• Fentanyl
• Mechanical ventilation
• Nefopam
• Vasopressors

• breathing pattern
• cipepofol
• inspiratory effort
• respiratory drive
• sedation

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

• Humans
• Pharmacists/organization & administration
• Intensive Care Units/organization & administration
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/etiology
• Sleep Wake Disorders/diagnosis
• Critical Illness/therapy
• Professional Role
• Sleep/physiology
• Sleep/drug effects

• Humans
• Male
• Intensive Care Units
• Mobile Applications
• Stress, Psychological/diagnosis
• Stress, Psychological/psychology
• Female
• Prospective Studies
• Feasibility Studies
• Middle Aged
• Critical Care/psychology
• Aged
• Adult
• Cohort Studies
• Critical Illness

• Cognitive impairment
• Critical care
• Intensive care
• PTSD
• Quality of life

• Humans
• Survivors/psychology
• Empathy
• Intensive Care Units/organization & administration
• Critical Care/organization & administration
• Quality of Life
• Critical Illness

• Acute respiratory failure
• Heated humidifier
• High flow nasal oxygen
• Hygrometry
• Non-invasive mechanical ventilation
• Oxygenation

• ICU nurses
• Physical Environmental Stress Scale
• nurse burnout
• physical environment
• stress mitigation

• Humans
• Intensive Care Units
• Occupational Stress
• Nursing Staff, Hospital/psychology
• Workplace/psychology
• Adult
• Female
• Surveys and Questionnaires
• Male
• Focus Groups
• Middle Aged
• Lighting
• Noise

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

• ICU noise
• environmental music therapy
• fragile hospital environments
• hospital environments
• music perception
• noise perception

• Child
• Humans
• Caregivers
• Intensive Care Units, Pediatric
• Medical Staff
• Noise
• Perception

• Adult
• Humans
• Caregivers/psychology
• Critical Illness
• Stress, Psychological/epidemiology
• Stress, Psychological/psychology
• Emotions
• Anxiety/epidemiology
• Anxiety/psychology
• Psychological Distress
• Family/psychology
• Depression

• K23 HL140165 NHLBI NIH HHS
• L30 HL133988 NHLBI NIH HHS
• R01 HL157361 NHLBI NIH HHS
• R01 HS028038 AHRQ HHS

Parents of critically ill children in the Pediatric Intensive Care Unit (PICU) commonly experience new or worsening anxiety, which can lead to long-term sequelae in the form of post-traumatic stress disorder (PTSD). To investigate how well the PICU providers recognize and assess parental anxiety, we assessed the acute and baseline anxiety level of 30 parents in the PICU with the State-Trait Anxiety Inventory (STAI) and compared the results with the PICU physician's and nurses' assessments. All but four parents experienced higher acute anxiety scores compared to baseline, with a 34% increase in the number of parents with moderate and high anxiety scores. All PICU providers performed poorly in recognizing and assessing parental anxiety, with a tendency to underestimate the level of anxiety. Proper screening tools and strategies are essential to recognize and help parents in distress and potentially prevent long-term psychological sequelae.

Opioids remain an essential part of the treatment of chronic pain. However, their use and increasing rates of misuse are associated with high morbidity and mortality. The development of tolerance to opioids and analgesics further complicates dosing and the need to reduce side effects. First-generation digital systems were developed to improve analgesics but are not always capable of making clinically relevant associations and do not necessarily lead to better clinical efficacy. A lack of improved clinical outcomes makes these systems less applicable for adoption by clinicians and patients. There is a need to enhance the therapeutic regimens of opioids. In the present paper, we present the use of a digital analgesic that consists of an analgesic administered under the control of a second-generation artificial intelligence system. Second-generation systems focus on improved patient outcomes measured based on clinical response and reduced side effects in a single subject. The algorithm regulates the administration of analgesics in a personalized manner. The digital analgesic provides advantages for both users and providers. The system enables dose optimization, improving effectiveness, and minimizing side effects while increasing adherence to beneficial therapeutic regimens. The algorithm improves the clinicians’ experience and assists them in managing chronic pain. The system reduces the financial burden on healthcare providers by lowering opioid-related morbidity and provides a market disruptor for pharma companies.

• algorithm
• analgesics
• digital health
• opioids
• tolerance

• actigraphy
• assessment
• electroencephalography
• intensive care
• polysomnography
• sleep

• Anesthesia
• Child
• Emergency Service, Hospital
• Humans
• Hypnotics and Sedatives/therapeutic use
• Intubation, Intratracheal

• Adult
• Child
• Emergency Service, Hospital
• Humans
• Hypnotics and Sedatives/adverse effects
• Infant, Newborn
• Intubation, Intratracheal
• Retrospective Studies
• Succinylcholine

• ICU experience
• intensive care
• perceived stress
• stressful experience
• stressor

• ECMO
• Post-intensive care syndrome
• Post-traumatic stress disorder

• acute coronary syndrome
• intensive care unit
• nursing
• stress

Flexible fiberoptic bronchoscopy is frequently used in intensive care unit, but is a source of discomfort, dyspnea and anxiety for patients. Our objective was to assess the feasibility and tolerance of a sedation using remifentanil target-controlled infusion, to perform fiberoptic bronchoscopy in awake ICU patients.

This monocentric, prospective observational study was conducted in awake patients requiring fiberoptic bronchoscopy. In accordance with usual practices in our center, remifentanil target-controlled infusion was used under close monitoring and adapted to the patient’s reactions. The primary objective was the rate of successful procedures without additional analgesia or anesthesia. The secondary objectives were clinical tolerance and the comfort of patients (graded from “very uncomfortable” to “very comfortable”) and operators (numeric scale from 0 to 10) during the procedure.

From May 2014 to December 2015, 72 patients were included. Most of them (69%) were hypoxemic and admitted for acute respiratory failure. No additional medication was needed in 96% of the patients. No severe side-effects occurred. Seventy-eight percent of patients described the procedure as “comfortable or very comfortable”. Physicians rated their comfort with a median [IQR] score of 9 [8–10].

Remifentanil target-controlled infusion administered to perform awake fiberoptic bronchoscopy in critically ill patients is feasible without requirement of additional analgesics or sedative drugs. Clinical tolerance as well as patients’ and operators’ comfort were good to excellent. This technique could benefit patients’ experience.

The online version contains supplementary material available at 10.1186/s13613-021-00832-6.

• Comfort
• Flexible fiberoptic bronchoscopy
• Intensive care unit
• Remifentanil target-controlled infusion
• Tolerance

Monitoring the pain intensity in critically ill patients is crucial because intense pain can cause adverse events, including poor survival rates; however, continuous pain evaluation is difficult. Vital signs have traditionally been considered ineffective in pain assessment; nevertheless, the use of machine learning may automate pain assessment using vital signs. This retrospective observational study was performed at a university hospital in Sendai, Japan. Objective pain assessments were performed in eligible patients using the Critical-Care Pain Observation Tool (CPOT). Three machine-learning methods—random forest (RF), support vector machine (SVM), and logistic regression (LR)—were employed to predict pain using parameters, such as vital signs, age group, and sedation levels. Prediction accuracy was calculated as the harmonic mean of sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Furthermore, 117,190 CPOT assessments were performed in 11,507 eligible patients (median age: 65 years; 58.0% males). We found that pain prediction was possible with all three machine-learning methods. RF demonstrated the highest AUROC for the test data (RF: 0.853, SVM: 0.823, and LR: 0.787). With this method, pain can be objectively, continuously, and semi-automatically evaluated in critically ill patients.

It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem.

The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters.

A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests.

The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements.

The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.

• Actigraphy
• Intensive Care Unit
• Richards-Campbell Sleep Questionnaire
• Sleep

• ICU
• Monitoring
• Non-contact vital signs
• Qualitative
• Systems engineering initiative for patient safety

• Adult
• Humans
• Intensive Care Units
• Monitoring, Physiologic
• Motivation
• Patient Safety
• Vital Signs

To investigate the viability of the bispectral index in the sleep evaluation of critically ill patients and to quantify the associations of sleep parameters measured by this index with the Richards-Campbell Sleep Questionnaire and environmental noise.

This was a cross-sectional observational study that evaluated critically ill adults with diseases of low or moderate severity. The following were measured: total sleep volume and time, deep sleep volume and time, continuous sleep volume and time, sleep onset latency, and environmental sound pressure level. The subjective perception of sleep was evaluated with the Richards-Campbell Sleep Questionnaire the morning after each night of observation.

Patients had a low total sleep time (234 minutes), a predominance of superficial sleep stages, and little deep sleep (1.7 minutes). The total, deep, and continuous sleep volumes were 3,679, 9.4, and 3,143 (bispectral index units × minutes), respectively. The sleep latency was 94 minutes. The mean score of the Richards-Campbell Sleep Questionnaire was 57.9. Total sleep volume, total sleep time, and continuous sleep volume were weakly correlated with the Richards-Campbell Sleep Questionnaire depth of sleep domain score, overall sleep quality domain score, and total score. Total volume, total time, and continuous volume were moderately correlated with the occurrence of awakenings domain score.

The bispectral index is an instrument with limited viability to monitor the sleep of lucid patients and patients with low to moderate disease severity in the intensive care unit. Patients with higher total sleep volume, total sleep time, and continuous sleep volume had better overall sleep perception.

• anxiety
• depression
• environmental stressors
• intensive care
• nursing

• Anxiety
• Control
• Physical Restraint
• Questionnaire
• Stress

• Anxiety
• Critical Care/psychology
• Female
• Humans
• Intensive Care Units
• Male
• Respiration, Artificial
• Stress, Psychological/psychology
• Surveys and Questionnaires

There exists little literature on situational health literacy - that is, how an individual’s health literacy varies across different health literacy environments. However, one can consider the role of stress when examining the relationship between health situations and decision-making ability, and by proxy health literacy. The aim of this study was to assess the strength of the evidence on the relationship between health situations and patient stress, considered in the context of health professional perception, and determine what health situations act to influence patient stress.

A systematic review of English articles using PubMed, PsycINFO, CINAHL and Embase databases was conducted. Search terms focused on ‘patient’, ‘stress’, and ‘health care situations’. Only peer-reviewed original research with data on patient stress in the context of a health facility environment was included. Studies were screened and critically appraised by both authors. Study elements for extraction were defined by RO and extracted by JY.

Twenty-four studies were included for narrative synthesis. Patients in Intensive Care Units were more stressed about factors relating to their physical discomfort, with some agreement from health care professionals. Parents of children in Intensive Care Units were more concerned with stressors relating to their child’s appearance and behaviour, and alteration in their parental role. Few studies examined health settings other than Intensive Care Units, and those that did varied greatly in terms of study design and population characteristics, lacking generalisability.

Overall, the findings of what patients find most stressful in Intensive Care Units can guide health care professionals practicing best practice care. However, the evidence on how patient stress is influenced by non-Intensive Care Unit health care settings is weak. Further research is needed to enhance current understanding of the interaction between patient stress and health care environments in both hospital and primary care settings.

• Environment
• Health facilities
• Health literacy
• Patients
• Stress

• actigraphy
• acute care
• circadian rhythms
• melatonin
• sleep
• traumatic brain injury

• Actigraphy
• Adult
• Brain Injuries/complications
• Brain Injuries/physiopathology
• Brain Injuries, Traumatic/complications
• Brain Injuries, Traumatic/physiopathology
• Circadian Clocks/physiology
• Circadian Rhythm/physiology
• Female
• Humans
• Male
• Melatonin/analogs & derivatives
• Melatonin/urine
• Middle Aged
• Polysomnography
• Sleep Wake Disorders/complications
• Sleep Wake Disorders/physiopathology
• Young Adult

• 115172 CIHR

There exist conflicting data regarding the accuracy of ICU nurses accurately assessing patient sleep using validated questionnaires. Using the Richards-Campbell Sleep Questionnaire (RSQ), we hypothesize that patient factors might influence nursing perception of their sleep.

Patients in the ICU who met the inclusion criteria were asked to complete the sleep questionnaire, as were their nurses and intraclass correlation analysis was done.

38 paired patient-nurse surveys were included for analysis. The mean difference in total average score of the RSQ was not significantly different between patients and nurses. There was fair intraclass correlation by patient age, black race, and admission for respiratory illnesses. A good intraclass correlation existed for non-blacks and admission for non-respiratory reasons. Most striking was the intraclass correlation by sex, with poor intraclass correlation for women compared to an excellent correlation for men.

The results of our study confirm that patients in our ICU have poor sleep with a fair intraclass correlation. When examined by patient related factor, the greatest divergence between patient and nursing perception of sleep in the ICU using the RCSQ was patient female sex. More research is needed in this area to better understand the divergence and improve sleep in the ICU.

• Enhanced recovery after surgery program
• fast-track surgery and hepatopancreatobiliary surgery
• stress levels and surgery

• acute care
• biomarker
• burns
• healing
• inflammation
• perioperative care

• Anxiety/psychology
• Anxiety/therapy
• Critical Illness/psychology
• Critical Illness/therapy
• Humans
• Music Therapy/methods
• Randomized Controlled Trials as Topic
• Stress, Psychological/psychology
• Stress, Psychological/therapy

This review aimed to study the role of analgesia and sedation after coronary artery bypass graft (CABG) surgery, regarding pain management, assisted respiration, overall postoperative health care, and hospitalization. Data were collected from Pubmed, Scopus, and Cochrane databases. The following terms were used for the search: “analgesia”, “sedation”, “coronary artery bypass grafting”, CABG”, and “opioids”. Articles between the years 1988 and 2018 were evaluated. Several opioid and non-opioid analgesics used to relieve surgical pain are regarded as critical risk factors for developing pulmonary and cardiovascular complications in all kinds of thoracic surgery, especially CABG procedures. Effective pain management in post-CABG patients is largely dependent on effective pain assessment, type of sedatives and analgesics administered, and evaluation of their effects on pain relief. A significant challenge is to determine adequate amounts of administered analgesics and sedatives for postoperative CABG patients, because patients often order more sedatives and analgesics than needed. The pain management process is deemed successful when patients feel comfortable after surgery, with no negative side effects. However, postoperative pain management patterns have not included many modern methods such as patient-controlled analgesia, and postoperative pain management drugs are still limited to a restricted range of opioid and non-opioid analgesics.

• ICU
• analgesia
• coronary artery bypass grafting (CABG)
• opioids
• sedation

• analgesics
• chronic pain
• critical care
• opioids
• pain

• Analgesics, Opioid/adverse effects
• Analgesics, Opioid/pharmacology
• Analgesics, Opioid/therapeutic use
• Critical Illness/therapy
• Drug Tolerance
• Humans
• Hyperalgesia/chemically induced
• Intensive Care Units
• Neurons/drug effects
• Pain Management
• Pain Measurement
• Pain Threshold

• R01 GM118947 NIGMS NIH HHS

• Bubble humidification
• Intensive care units
• Nursing assessment
• Oxygen therapy
• Patient comfort

• PHRI 2010-02 Direction Générale de l'offre de Soins
• Direction Générale de l’offre de Soins

• accelerometry
• critical care
• critical illness
• intensive care units
• sleep deprivation

• Actigraphy/methods
• Critical Illness
• Feasibility Studies
• Humans
• Intensive Care Units
• Nurses
• Polysomnography
• Reproducibility of Results
• Self Report
• Sleep

• K76 AG059936 NIA NIH HHS
• UL1 TR000124 NCATS NIH HHS
• UL1 TR001881 NCATS NIH HHS

• analgesic
• critically ill patient
• intensive care unit (ICU)
• sedative

• adult psychiatry

• Attitude of Health Personnel
• Critical Care Nursing/education
• Critical Care Nursing/methods
• Feasibility Studies
• Humans
• Nursing Staff, Hospital/education
• Patient Satisfaction
• Practice Patterns, Nurses'
• Psychosocial Support Systems
• Relaxation Therapy
• Stress Disorders, Post-Traumatic/prevention & control
• Stress, Psychological/prevention & control

• 12/64/124 Department of Health
• National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme

• intensive care unit
• mechanical ventilation
• quality of sleep

• echocardiogram
• guideline
• intensive care unit
• pulmonary embolism
• trans-thoracic echocardiography

• Acute Disease
• Echocardiography/methods
• Female
• Follow-Up Studies
• Heart Ventricles/diagnostic imaging
• Heart Ventricles/physiopathology
• Hemodynamics/physiology
• Hospital Mortality/trends
• Hospitalization/statistics & numerical data
• Humans
• Male
• Middle Aged
• Prognosis
• Pulmonary Embolism/diagnosis
• Pulmonary Embolism/mortality
• Pulmonary Embolism/physiopathology
• Reproducibility of Results
• Retrospective Studies
• Survival Rate/trends
• Time Factors
• United States/epidemiology

• K01 HL116768 NHLBI NIH HHS
• K24 HL132008 NHLBI NIH HHS
• T32 HL007035 NHLBI NIH HHS