A Randomized Controlled Trial of Direct Noise Reduction in the ICU Using Overnight Application of In-ear Earplugs or In-ear Earplugs Plus Noise-Canceling Headphones to Reduce the Incidence and Duration of ICU Delirium
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 8
- 试验地点
- 2
- 主要终点
- Days Free of Delirium or Coma
研究概览
简要总结
This study seeks to examine the effects of overnight noise reduction in critically ill patients who are receiving mechanical ventilation. The investigators will randomly place subjects into one of three groups: 1) usual care 2) overnight earplugs 3) overnight earplugs and noise-canceling headphones. The investigators will monitor for safety, and will measure the amount of delirium experienced by subjects, record the amount of sedating and painkilling medicines required, and measure sleep quality during the study, among other information. The investigators will also measure noise levels experienced by patients in each group. The investigators predict that the use of overnight noise reduction will be safe and will reduce the amount of delirium by improving the quality of sleep in critically ill patients.
详细描述
Delirium is an acute confusional state defined by fluctuating mental status, inattention, and either disorganized thinking or an altered level of consciousness. Acute delirium is an increasingly recognized problem in intensive care units (ICUs) in the US and worldwide. ICU Delirium has been estimated to occur in as many as 50 to 80 percent of ICU patients. Delirium in the ICU has been associated with worsened clinical outcomes such as prolonged hospitalization and death [1-4]. Although noise has been shown to negatively influence sleep in the ICU, and sleep disturbance is a recognized contributor to ICU delirium[1-2, 4], there is no well-established link between ICU noise levels and the development of ICU delirium. Optimal strategies for the prevention and treatment of ICU delirium are yet to be defined, and this study will focus on a novel noise-reduction approach which has potential to impact both prevention and treatment [5-8]. Findings will be generalizable to other tertiary care medical intensive care units caring for adult patients.
Objectives Our multidisciplinary team will evaluate the safety and feasibility of direct noise reduction in the Wake Forest University Baptist Medical Center (WFUBMC) Medical Intensive Care Unit (MICU), and any effect on the incidence of ICU delirium.
Methods and Measures Design
- Forty-five (45) patients receiving mechanical ventilation will be randomized to receive either passive direct noise reduction (earplugs), both passive and active direct noise reduction (earplugs and noise-canceling headphones), or no direct noise reduction (usual practice).
- Ambient noise levels and the reduction in noise accomplished by direct noise reduction will be measured according to standardized audiometric techniques.
- Sleep structure, including amount of recovery sleep, will be measured over one night according to standardized polysomnographic (sleep study) techniques
- The incidence of delirium will be assessed as well as multiple other endpoints including but not limited to amount of psychoactive medication prescribed and amount of physical restraints required.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients who are admitted to our MICU for at least 24 hours with at least 72 hours' additional expected stay in ICU, and who are mechanically ventilated
排除标准
- •severe to profound hearing loss
- •baseline use of hearing aids
- •eardrum perforation
- •severe cerumen impaction
- •head or oromaxillofacial trauma
- •external ventricular drain or intracranial pressure monitoring devices
- •comatose patients who are deemed by their attending physician as unlikely to awaken within 72 hours
- •patient status as comfort-measures only
- •any other contraindication to the use of earplugs or headphones
研究组 & 干预措施
Usual Care
Usual Care between 10pm-6am
Earplugs
Application of foam earplugs from 10pm-6am nightly for seven nights or until ICU discharge.
干预措施: Foam Earplugs (Device)
Earplugs and Headphones
Foam Earplugs and Noise canceling headphones applied from 10pm-6am nightly for 7 nights or until ICU discharge.
干预措施: Foam Earplugs (Device)
Earplugs and Headphones
Foam Earplugs and Noise canceling headphones applied from 10pm-6am nightly for 7 nights or until ICU discharge.
干预措施: Noise Canceling Headphones (Device)
结局指标
主要结局
Days Free of Delirium or Coma
时间窗: During the Study Period (Study Days 0-7 while patients were in ICU)
次要结局
- Amount of Sedative Use (Propofol and Demedetomidine )(During the Study Period (Study Days 0-7))
- Noise Attenuation(Overnight (10pm-6am) on study day 2 or 3.)
- Sleep Efficiency and Architecture(Overnight (10pm-6am) on study day 2 or 3)
- Amount of Analgesic Use(During the Study Period (Study Days 0-7))
- Amount of Sedative Use (Midazolam and Lorazepam)(During the Study Period (Study Days 0-7))