Article

Actigraphy in the critically ill: Correlation with activity, agitation, and sedation

Adult Health Department of the School of Nursing, Virginia Commonwealth University Health System, Richmond, VA, USA.
American Journal of Critical Care (Impact Factor: 1.6). 02/2005; 14(1):52-60.
Source: PubMed

ABSTRACT To determine the feasibility of continuous measurement of limb movement via wrist and ankle actigraphy (an activity measure) in critically ill patients and to compare actigraphy measurements with observed activity, subjective scores on sedation-agitation scales, and heart rate and blood pressure of patients.
In a prospective, descriptive, correlational study, all activity of 20 adult patients in medical and coronary care units in a university medical center were observed for 2 hours and documented. Wrist and ankle actigraphy, heart rate, and systolic and diastolic blood pressure data were collected every minute. The Comfort Scale and the Richmond Agitation-Sedation Scale were completed at the beginning of the observation period and 1 and 2 hours later.
Wrist actigraphy data correlated with scores on the Richmond Agitation-Sedation Scale (r = 0.58) and the Comfort Scale (r = 0.62) and with observed stimulation and activity events of patients (r = 0.45). Correlations with systolic, diastolic, and mean arterial pressures were weaker. Wrist and ankle actigraphy data were significantly correlated (r = 0.69; P < .001); however, their mean values (wrist, 418; ankle, 147) were significantly different (t = 5.77; P < .001).
Actigraphy provides a continuous recording of patients' limb movement. Actigraphy measurements correlate well with patients' observed activity and with subjective scores on agitation and sedation scales. Actigraphy may become particularly important as a continuous measurement of activity for use in behavioral research and may enhance early recognition and management of the excessive activity that characterizes agitation.

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    • "Agitation is referred to as excessive restlessness, usually non purposeful mental and physical activity associated with anxiety. Agitation of the intubated patient in the intensive care unit is often due to pain, confusion, delirium, withdrawal, and adverse effects of drugs (Grap et al 2005, p. 52). Chang et al (2009) conducted a three year retrospective case-control study aimed at identifying the risk factors associated with unplanned and self extubation of the intubated patient. "
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    • "In ICU, patient limb movements indicate nursing interventions and purposeful or nonpurposeful activity [13]. Actigraphy has rarely been tested as a measure of agitation/sedation in ICU patients in relation with analgesic and sedative therapy [7] or in evaluating sleep time [13]. It could become particularly important as a continuous measurement of activity to enhance early recognition and management of the excessive activity that characterizes agitation; besides, if the depth of sedation was greater, less limb movements might be expected. "
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