title: Actigraphic monitoring in critically ill patients: preliminary results toward an "observation-guided sedation".
abstract: OBJECTIVE
  The aim of this study is to evaluate continuous wrist actigraphy (measurement of limb movements) in intensive care unit patients as a neurologic status monitoring.
  
  
  METHODS
  This is a prospective, observational study on motor activity of adult patients using wrist actigraphs. Nurses recorded the number of sleep and agitation hours as well as assessed pain and anxiety level (verbal numeric rating) and the agitation/sedation level (Richmond Agitation-Sedation Scale).
  
  
  RESULTS
  Thirteen mechanically ventilated patients were studied during their whole intensive care unit stay (total, 165 patients/d). The number of surveyed movements was gathered for each hour, obtaining an estimation of patient motor status. This measure was different between days and nights (33.3 [20.3-49.0] vs 8.5 [4.4-13.8]; P < .001), with a correlation with sleeping hours estimated by nurses (P = .017 during the days [D], P < .001 during the nights [N]), agitation hours (P = .002 D, P = .017 N), Richmond Agitation-Sedation Scale value (P < .001 D and N), pain (P = .012 D), and anxiety (P < .001 D) verbal numeric rating. No differences were found using epochs of 15 or 120 seconds. Compliance with patients and nurses was acceptable.
  
  
  CONCLUSIONS
  Patients' limb movements were significantly related to all studied neurologic status indexes. Continuous actigraphy measuring may become important as a clinical tool both to guide utilization of sedative drugs and to enhance early recognition and management of agitation.
authors: Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, Azienda Ospedaliera San Paolo-Polo Universitario, 20142 Milano, Italy. giovanni.mistraletti@unimi.it
authors: Giovanni
authors: G
authors: Mistraletti
authors: Martina
authors: M
authors: Taverna
authors: Giovanni
authors: G
authors: Sabbatini
authors: Elisabetta
authors: E
authors: Carloni
authors: Luca
authors: L
authors: Bolgiaghi
authors: Massimiliano
authors: M
authors: Pirrone
authors: Marco
authors: M
authors: Cigada
authors: Anne Lucia Leona
authors: AL
authors: Destrebecq
authors: Franco
authors: F
authors: Carli
authors: Gaetano
authors: G
authors: Iapichino
mesh_terms: D056044:Actigraphy; D000368:Aged; D001007:Anxiety / Q000188:drug therapy; D016638:Critical Illness; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D014953:Wrist
chemical_list: D006993:Hypnotics and Sedatives