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Comparison of Sleep Quality With Mechanical Versus Spontaneous Ventilation During Weaning of Critically Ill Tracheostomized Patients*

Roche-Campo, Ferran MD1–3; Thille, Arnaud W. MD1,2,4; Drouot, Xavier MD5,6; Galia, Fabrice Biomed Eng1,2; Margarit, Laurent MSc5; Córdoba-Izquierdo, Ana MD1,2,7; Mancebo, Jordi MD3; d’Ortho, Marie-Pia MD1,8; Brochard, Laurent MD1,2,9

doi: 10.1097/CCM.0b013e318287f569
Clinical Investigations

Background: In mechanically ventilated patients under mechanical ventilation in the ICU, ventilatory mode or settings may influence sleep quality. The aim of this study was to evaluate the direct impact of mechanical ventilation per se on sleep quantity and quality in patients who were able to tolerate separation from mechanical ventilation over prolonged periods.

Design and Setting: Randomized crossover clinical trial in a medical ICU.

Patients: Sixteen conscious patients, free of sedation and tracheostomized because of prolonged weaning from mechanical ventilation, were included in the study when able to tolerate at least 5 hours of spontaneous ventilation.

Interventions: Patients were randomized to receive either spontaneous ventilation or mechanical ventilation at low levels of pressure support for two crossover periods of 5-hour duration each, from 22:00 to 08:00. Polysomnography was performed throughout the study.

Measurements and Results: Total sleep time was higher during mechanical ventilation than during spontaneous ventilation (183 min vs 132 min, p = 0.04). No significant differences between mechanical ventilation and spontaneous ventilation were observed in slow wave sleep time (45 min vs 28 min), rapid eye movement sleep time (11 min vs 3 min), or the fragmentation index (25 vs 23 arousals and awakenings per hr). In four patients, however, our analysis of patient–ventilator interaction suggested that the ventilatory settings were suboptimal and could have been improved to potentially improve sleep.

Conclusions: In difficult-to-wean tracheostomized patients, sleep quality was similar with or without the ventilator. Sleep quantity was higher during mechanical ventilation. Reconnection to the ventilator during the night period may favor sleep efficiency in tracheostomized patients in prolonged weaning.

1AP-HP, Medical Intensive Care Unit, Groupe Hospitalier Albert Chenevier—Henri Mondor, Créteil, France.

2Mondor Biomedical Research Center (INSERM U955), University of Paris EST, Créteil, France.

3Intensive Care Unit, Hospital de Sant Pau, Barcelona, Spain.

4Intensive Care Unit, Universitary Hospital of Poitiers. Poitiers, France.

5AP-HP, Department of Physiology, Groupe Hospitalier Albert Chenevier—Henri Mondor, Créteil, France.

6University of Paris EST, Excitabilité Nerveuse et Thérapeutique, Créteil, France.

7Department of Pneumology, Hospital de Bellvitge, Barcelona, Spain.

8AP-HP, Department of Physiology, Bichat Hospital, Paris, France.

9Medical Intensive Care Unit, University Hospital, University of Geneva, Geneva, Switzerland.

*See also p. 1808.

Dr. Roche-Campo received a grant from the Société de Réanimation de Langue Française (SRLF) and the Société de Pneumologie de Langue Française (SPLF). Dr. Drouot has board membership with UCB Pharma and receives grant support from UCB Pharma, payment for lectures from UCB Pharma. Dr. Mancebo is a board member for Air-Liquide and a consultant for Faron, Philips-Respironics, ALung, and has grants/pending with General Electric. Dr. d'Ortho has board membership ResMed and Bioproject, and grants/pending with ResMed and Philips, payment for lectures: Vitalaire, Philips, IPSEN, travel accommodations: Orkyn. Dr. Brochard has grants/pending from Philips Respironics, Drager, Covidien, Maquet–grants for research on NIV, SmartCare, PAV, NAVA. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: ferranroche@yahoo.es

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins