***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Many intensive care patients experience sleep disruption potentially related tonoise , light and treatment interventions . The purpose of this study was tocharacterise , in terms of quantity and quality , the sleep of intensive care patients , taking into account the impact of environmental factors . Methods This observational study was conducted in the adult ICU of a tertiary referralhospital in Australia , enrolling 57 patients .  Polysomnography ( PSG ) was performedover a 24-hour period to assess the quantity ( total sleep time : hh : mm ) and quality ( percentage per stage , duration of sleep episode ) of patients ' sleep while in ICU.Rechtschaffen and Kales criteria were used to categorise sleep . Interrater checkswere performed . Sound pressure and illuminance levels and care events weresimultaneously recorded . Patients reported on their sleep quality in ICU using theRichards Campbell Sleep Question naire and the Sleep in Intensive Care Question naire . Data were summarised using frequencies and proportions or measures of central tendency and dispersion as appropriate and Cohen 's Kappa statistic wasused for interrater reliability of the sleep data analysis . Results Patients ' median total sleep time was 05:00 ( IQR : 02:52 to 07:14 ) . The majority ofsleep was stage 1 and 2 ( medians : 19 and 73 % ) with scant slow wave and REM sleep . The median duration of sleep without waking was 00:03 . Sound levels were high(mean Leq 53.95 dB(A ) during the day and 50.20 dB(A ) at night ) and illuminancelevels were appropriate at night ( median < 2 lux ) but low during the day(median : 74.20 lux ) . There was a median 1.7 care events/h . Patients ' meanself-reported sleep quality was poor . Interrater reliability of sleep staging washighest for slow wave sleep and lowest for stage 1 sleep . Conclusions The quantity and quality of sleep in intensive care patients are poor and may berelated to noise , critical illness itself and treatment events that disturb sleep . The study highlights the challenge of quantifying sleep in the critical care setting and the need for alternative methods of measuring sleep . The results suggest that a sound reduction program is required and other interventions toimprove clinical practice s to promote sleep in intensive care patients .Trial registration Australian New Zeal and clinical trial registry(http://www.anzctr.org.au/ ) : ACTRN12610000688088 Introduction Environmental stimulus , especially noise and light , is thought to disrupt sleep in patients in the intensive care unit ( ICU ) . This study aim ed to determine the physiological and psychological effects of ICU noise and light , and of earplugs and eye masks , used in these conditions in healthy subjects . Methods Fourteen subjects underwent polysomnography under four conditions : adaptation , baseline , exposure to recorded ICU noise and light ( NL ) , and NL plus use of earplugs and eye masks ( NLEE ) . Urine was analyzed for melatonin and cortisol levels . Subjects rated their perceived sleep quality , anxiety levels and perception of environmental stimuli . Results Subjects had poorer perceived sleep quality , more light sleep , longer rapid eye movement ( REM ) latency , less REM sleep when exposed to simulated ICU noise and light ( P < 0.05 ) . Nocturnal melatonin ( P = 0.007 ) and cortisol secretion levels ( P = 0.004 ) differed significantly by condition but anxiety levels did not ( P = 0.06 ) . Use of earplugs and eye masks result ed in more REM time , shorter REM latency , less arousal ( P < 0.05 ) and elevated melatonin levels ( P = 0.002 ) . Conclusions Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light , making their promotion in ICU patients reasonable BACKGROUND Post-anaesthesia care units ( PACUs ) with 24/7 activity and consequently artificial light and noise may disturb the sleep of patients who require prolonged medical supervision . After one postoperative night , we compared sleep quality in patients with and without noise ( earplug ) and light ( eye mask ) protection . METHODS After ethical board approval , 46 patients without any neurological or respiratory failure undergoing major non-cardiac surgery were prospect ively included . They were r and omized to sleep with or without protective devices during the first postoperative night in the PACU . Sleep quality was simultaneously measured by sleep- quality scales ( Spiegel score and Medical Outcomes Study Sleep ) ,  nurses ' assessment , and through a wrist actigraph ( Actiwatch ) . Secondary outcomes such as pain control and nocturnal activity were recorded . Comparisons between groups were made by Student 's t-test or non-parametric test for repeated measures as appropriate ( SPSS 10.0 ) . A P-value < 0.05 was considered significant . RESULTS Data from 41 patients were analysed . Protective devices during the first postoperative night prevented a decrease in sleep quality compared with st and ard care , as evaluated by the Spiegel scale : 20 ( 4 ) vs 15 ( 5 ) , P=0.006 . These devices significantly decreased the need for a nap [ 50 % 95 % confidence interval ( CI ) ( 20 - 80 ) vs 95 % 95 % CI ( 85 - 100 ) , P<0.001 ] , but had no effect on sleep length evaluated by Actiwatch . The total consumption of morphine was significantly reduced in the first 24 h [ respectively , 15(12 ) mg and 27(17 ) mg , P=0.02 ] . CONCLUSIONS Earplugs and eye masks applied in the PACU during the first postoperative night significantly preserve sleep quality . Such non-invasive and cheap devices may be generalized in the PACU or in intensive care units Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in 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 . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , 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 . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT Objectives : To determine the relationship between the number of delirium days experienced by intensive care patients and mortality , ventilation time , and intensive care unit stay .  Design : Prospect i ve cohort analysis . Setting : Patients from 68 intensive care units in five countries . Patients : Three hundred fifty-four medical and surgical intensive care patients enrolled in the SEDCOM ( Safety and Efficacy of Dexmedetomidine Compared with Midazolam ) trial received a sedative study drug and completed at least one delirium assessment . Interventions : Sedative drug interruption and /or titration to maintain light sedation with daily arousal and delirium assessment s up to 30 days of mechanical ventilation . Measurements and Main Results : The primary outcome was all-cause 30-day mortality . Multivariable analysis using Cox regression incorporating delirium duration as a time-dependent variable and adjusting for eight relevant baseline covariates was conducted to quantify the relationship between number of delirium days and the three main outcomes . Overall , delirium was diagnosed in 228 of 354 patients ( 64.4 % ) . Mortality was significantly lower in patients without delirium compared to those with delirium ( 15 of 126 [ 11.9 % ] vs. 69 of 228 [ 30.3 % ] ; p < .001 ) . Similarly , the median time to extubation and intensive care unit discharge were significantly shorter among nondelirious patients ( 3.6 vs. 10.7 days [ p < .001 ] and 4 vs. 16 days [ p < .001 ] , respectively ) . In multivariable analysis , the duration of delirium exhibited a nonlinear relationship with mortality ( p = .02 ) , with the strongest association observed in the early days of delirium . In comparison to 0 days of delirium , an independent dose-response increase in mortality was observed , which increased from 1 day of delirium ( hazard ratio , 1.70 ; 95 % confidence interval , 1.27–2.29 ; p < .001 ) , 2 days of delirium ( hazard ratio , 2.69 ; confidence interval , 1.58–4.57 ; p < .001 ) , and ≥3 days of delirium ( hazard ratio , 3.37 ; confidence interval , 1.92–7.23 ; p < .001 ) . Similar independent relationships were observed between delirium duration and ventilation time and intensive care length of stay . Conclusions : In ventilated and lightly se date d intensive care unit patients , the duration of delirium was the strongest independent predictor of death , ventilation time , and intensive care unit stay after adjusting for relevant covariates Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Rationale  Delirium incidence in intensive care unit ( ICU ) patients is high and associated with poor outcome . Identification of high-risk patients may facilitate its prevention . Purpose To develop and vali date a model based on data available at ICU admission to predict delirium development during a patient ’s complete ICU stay and to determine the predictive value of this model in relation to the time of delirium development . Methods Prospect i ve cohort study in 13 ICUs from seven countries .  Multiple logistic regression analysis was used to develop the early prediction ( E-PRE-DELIRIC ) model on data of the first two-thirds and vali date d on data of the last one-third of the patients from every participating ICU . Results In total , 2914 patients were included . Delirium incidence was 23.6 % . The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission : age , history of cognitive impairment , history of alcohol abuse , blood urea nitrogen , admission category , urgent admission , mean arterial blood pressure , use of corticosteroids , and respiratory failure . The area under the receiver operating characteristic curve ( AUROC ) was 0.76 [ 95 % confidence interval ( CI ) 0.73–0.77 ] in the development data set and 0.75 ( 95 % CI 0.71–0.79 ) in the validation data set . The model was well calibrated . AUROC increased from 0.70 ( 95 % CI 0.67–0.74 ) , for delirium that developed < 2 days , to 0.81 ( 95 % CI 0.78–0.84 ) , for delirium that developed > 6 days . Conclusion Patients ’ delirium risk for the complete ICU length of stay can be predicted at admission using the E-PRE-DELIRIC model , allowing early preventive interventions aim ed to reduce incidence and severity of ICU delirium Purpose : Sleep deprivation may be particularly detrimental to intensive care unit ( ICU ) patients . Polysomnography has demonstrated abnormal sleep in medical and surgical ICU population s. Both environmental factors and circadian disruption have been implicated . We hypothesized that patients in a neurologic ICU would demonstrate similar sleep disturbances and that a combination of sleep-promoting interventions would increase sleep time . Methods : Twelve patients were enrolled in this pilot-r and omized , controlled , study in a neurologic ICU . For adult patients undergoing continuous EEG for clinical purpose s ,  noise-cancelling headphones and eye masks were worn , and an oral dose of melatonin was administered for 3 days , or until EEG was stopped . Sleep was scored according to st and ard criteria ; EEG was characterized and analyzed quantitatively . Results : Sixty-five percent of the patients ' recordings were unscorable based on accepted st and ardized criteria ; therefore , sleep measures could not be compared . For those with sleep that could be scored , total sleep time was normal , although sleep was fragmented and time spent in slow-wave or rapid eye movement sleep was notably decreased . Patients with unscorable recordings had worse injury severity measures , absent or significantly slower posterior dominant rhythm , and less coherence of posterior faster frequencies . Clinical outcomes were similar between intervention and control groups . Conclusions : Although sleep-promoting interventions were feasible , sleep quantification based on currently accepted criteria limited the ability to score sleep . Similar to other ICUs , sleep in 
    Output:
    
Placement of earplugs in patients admitted to the ICU , either in isolation or as part of a bundle of sleep hygiene improvement , is associated with a significant reduction in risk of delirium .