ICU Cases · Delirium & sleep
Hot case — the bedside: the patient who cannot sleep
A CICM hot case on the ICU sleep disruption and the delirium — the clustered care, the lights-off, the earplugs, the nocturnal dexmedetomidine, and the day-night cycle restoration.
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Prompt
At the bedside of a patient on day 5 of the ICU who has not slept for 3 nights, is becoming delirious, and is agitated at night. Assess and manage.
Presentation
You are taken to the bedside of a 60-year-old man on day 5 of a prolonged ICU admission. He is agitated at night, sleepy by day, and the CAM-ICU became positive 2 days ago. The nursing notes show frequent nocturnal interventions (the vital signs hourly, the medications, the dialysis at 3 am). The overhead lights are on continuously.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.