Comment in:
Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes.
Cabello B, Thille AW, Drouot X, Galia F, Mancebo J, d'Ortho MP, Brochard L.
Réanimation médicale, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil, France. MCabello@santpau.es
OBJECTIVES: To compare the influence of three ventilatory modes on sleep. DESIGN: Prospective, comparative, crossover study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: Fifteen conscious, nonsedated, mechanically ventilated patients. INTERVENTIONS: Patients were successively ventilated with assist-control ventilation, clinically adjusted pressure support ventilation (cPSV), and automatically adjusted pressure support ventilation (aPSV). Sleep polysomnography was performed during three consecutive 6-hr periods, one with each mode in random order. Airway pressure and thorax and abdomen plethysmography were used to diagnose central apneas and ineffective efforts. MEASUREMENTS AND MAIN RESULTS: The main abnormalities were a low percentage of rapid eye movement (REM) sleep counting, for a median (25th-75th percentiles) of 10% (3.5-12.5) of total sleep, and a highly fragmented sleep with 29 arousals and awakenings per hour of sleep. REM sleep duration was similar in the three ventilatory modes, 7% in assist-control, 4% in aPSV, and 1% during cPSV (p = .54), as well as in the fragmentation index, 31 arousals and awakenings per hour in assist-control, 32 in aPSV, and 34 during cPSV (p = .62). Ineffective efforts occurred similarly with the three modes (seven per hour of sleep in assist-control, 16 in aPSV, and 12 during cPSV) or central apneas during PSV (five in aPSV, seven during cPSV). Minute ventilation was similar with the three modes. CONCLUSIONS: In conscious, mechanically ventilated patients, sleep architecture was highly abnormal, with a short REM stage and a high degree of fragmentation. The ventilatory mode did not influence sleep pattern, arousals, awakenings, and ineffective efforts.
Publication Types:
PMID: 18496373 [PubMed - indexed for MEDLINE]