Actigraphy in the critically ill: Correlation with acitivity, agition, 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: 2.12).
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.
Available from: Jolynn Mutamba
- "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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ABSTRACT: Unplanned or self extubations is a quality issue that can have a detrimental effect on patients, their families, hospital resources and funds. Unplanned extubations have been linked to increased lengths of hospital stay without affecting mortality rates (1). Endotracheal tube movement or dislodgement can damage a patient’s airway, and cause a lot of discomfort and pain to the intubated patient. Frequently reported complications of unplanned extubation are respiratory and cardiac in nature.
Objective: a search of the literature has been conducted to establish which method of fixating endotracheal tubes is superior in reducing the incidence of unplanned extubations.
Methods: A search of the literature was conducted to establish which method of fixating endotracheal tubes provides a superior method of securing the endotracheal tube.
Results: The cotton cloth tape method appears to potentially provide a safe, secure, superior method of fixating the endotracheal tube. Further research needs to be conducted on this method, as it has been linked to an unsupported, accepted theoretical risk of causing decreased venous return.
Conclusion: Despite a vast amount of research studies conducted on the methods of fixating endotracheal tubes in the ventilated patient, none of the studies were able to conclusively demonstrate the superiority of one particular fixating method.
Available from: Giovanni Mistraletti
- "In ICU, patient limb movements indicate nursing interventions and purposeful or nonpurposeful activity . Actigraphy has rarely been tested as a measure of agitation/sedation in ICU patients in relation with analgesic and sedative therapy  or in evaluating sleep time . 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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ABSTRACT: 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.
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).
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.
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.
Available from: Michael A E Ramsay
- "Face, construct, or criterion validity has been demonstrated for many of the domains of these instruments using a variety of comparators. These comparators include expert opinion [40,41,59], quantity of sedative drug administered [40,41,58], visual-analog scales [39,59,61], other sedation instruments [36,39,41,58,62], processed electroencephalography (EEG) such as Bispectral Index (BIS) and Patient State Index (PSI) [61,63-69], and limb acceleration and movement using actigraphy  or digital imaging  (Table 3). In most cases good to excellent validity is demonstrated. "
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ABSTRACT: Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value.
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