Intensive care patients usually
develop delirium or confusion, characterized by a changed level of
consciousness affecting the clarity and the coherence of their thinking, very
early after admission.
Not so much the
sound of the ICU equipments, rather, phones ringing and people talking seem to
disturb the sleep of the patients. Research shows that this disturbance in
sleep could be the cause of early onset of delirium and confusion. This type of
delirium sets in the first days after admission. The later onset of delirium is
caused by the severity of illness, biomedical situation or is treatment
Bart Van Rompaey and colleagues from the University
of Antwerp, Belgium, focused their research on the early onset of delirium and
conducted a study to find out if reduction of sound during the
night using earplugs could help prevent the early onset of intensive care
The trial included an intervention group
of 69 patients sleeping with earplugs during the night and a control group of
67 patients sleeping without earplugs during the night. Patients were all
adults and were expected to stay in the ICU for more than 24 hours. Delirium
was assessed using NEECHAM scale and sleep perception was reported by the
patient in response to five questions.
showed that -
• The use of earplugs during the night showed a 43 percent lower risk for
confusion in the ICU. The beneficial effects seem to be strongest within 48
hours after admission.
• Patients sleeping with earplugs developed confusion later than the
patients sleeping without earplugs.
• After the first night in the ICU, patients sleeping with earplugs
reported a better sleep perception.
• There is a relation between environmental sound, sleep perception and
in the ICU is a 'multifactorial syndrome' with associated risk factors, so the
researchers caution that 'sleeping with earplugs is no magical solution in the
prevention of delirium'.
Again, the study
included only a specific population in the ICU, so the results may not be
applicable to all settings and all patients, they point out. Patients who did
not like to use earplugs did not give their consent to the study.
Interestingly, the larger group of refusals was women. They said that they
prefer remaining in direct contact with their environment. The researchers
suggest further research focusing on the reasons for this refusal.
concluded that earplugs could be a useful instrument in the prevention of
delirium or confusion. 'The use of earplugs, however, is cheap, easy and has
apparently the same effect on all patients without the necessity to introduce
more extensive structural or organizational changes on the ward', say the
Van Rompaey B, Elseviers MM, Van Drom W, Fromont
V, Jorens PG. The effect of earplugs during the night on the onset of delirium
and sleep perception: a randomized controlled trial in intensive care patients.
Crit Care 2012.