Do earplugs and eye masks affect sleep and delirium outcomes in the critically ill?

Humans use their senses to evaluate situations in which they find themselves. From birth and beyond, optimal survival requires accurate interpretation of senses of taste, touch, smell, sight, and sound. Hearing ranks as the most important sense after sight. Critically ill adults are vulnerable when admitted to the intensive care unit (ICU) because patients are bombarded with unfamiliar sounds, bright lights, and interruptions, creating a potentially hostile environment. Imagine waking up to the sounds of a bedside computer keeping track of blood pressure, heart rate, and respiratory rate or oxygen saturation; mechanical ventilation; continuous lateral rotation; feeding pumps; external pneumatic compressions devices; medication pumps and a continuous Yankauer suction setup tucked under a pillow. Then consider audible alarms from any 1 or 2 of those technical devices. Now interpret those sounds accurately. And by the way, the 10-member multidisciplinary team is rounding in the hallway just outside your room. Several loud voices are heard discussing medication profiles and treatment plans. Interpret those sounds as well. Noisy ICUs and bright lights are undesirable because evidence shows that such stimuli can cause both psychological and physiologic harm in an environment otherwise focused on recovery and healing. Negative psychological states such as agitation, confusion, and delirium follow the stimuli of sleepinterrupting noises or bright lights. The incidence of ICU-acquired delirium has been reported to be as low as 20% and as high as 80%. A continuously A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of questions for future review.