Chest
Volume 102, Issue 1, July 1992, Pages 288-291
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Polysomnography in Acutely III Intensive Care Unit Patients

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EDITOR'S NOTE. The gold standard in explanatory clinical research is the randomized, prospective, double-blind clinical trial. Such a study design, of course, differs radically from descriptive studies consisting of a case report or a series of case reports. Without comparisons, descriptive studies cannot explain the causes of disease or scientific phenomena, and they cannot offer evidence that one therapy is superior to another. Why, then, are we publishing the following article which is, in essence, a description of a series of cases? Descriptive studies continue to offer important information for the clinician if the limitations of such an investigational protocol are clearly identified for the critical reader. One of the reviewers who acted as an out-of-office consultant for the Editorial Board of Chest pointed out that “This is not a well-defined study with proven results; rather, it presents a series of patients which would be of considerable interest to the readership of Chest. In a sense, this paper is as much a good editorial as it is new science.” In the editorial offices of Chest we shall continue to accept excellent case report studies. We ask only that manuscripts should not hide the deficiencies of the study design; that is all we can ask of any good investigator. No experiment performed in the real world of man can be perfect. Every study, no matter how well designed, will have limitations which the reader must take into account when he or she assesses the validity and clinical relevance of the data. (Chest 1992; 102:288-91)

Section snippets

METHODS

We analyzed the data from nine acutely ill patients who underwent PSG in our sleep laboratory between November 1, 1988, and November 1, 1990. All patients were referred to our laboratory during their admissions to the medical ICUs of two teaching hospitals. All patients were in acute RF at the time of referral (ie, room air arterial blood gas values: PaO2 <50 mm Hg and/or PaCO2 >50 mm Hg). All patients underwent daytime PSG while still resident in the ICUs. No patient was studied while

RESULTS

The data for the patients are presented in Table 1. This was a heterogeneous group of nine patients. In six patients RF was due to obesity-related problems; in two, to neuromuscular disease; and in one, to end-stage COPD. They were all in RF with pH of 7.30 ± 0.03, PCO2 of 80.8 ± 8.6 mm Hg, and PO2 of 48.1 ± 6.8 mm Hg (values are mean ± SEM). Seven of the nine had associated cor pulmonale, five had coronary disease or arterial hypertension, and four had diabetes mellitus. Seven of nine subjects

DISCUSSION

Polysomnography can be extremely useful in certain acutely ill patients. Patients with unexplained respiratory failure and a suspected sleep disorder require urgent diagnosis and treatment; this is possible if evaluation of sleep and breathing is performed while they are acutely ill. These patients are frequently unstable and are not easily brought into the sleep laboratory. Our medical center does not have a portable PSG system, and we described the procedures we used in studying these

CONCLUSION

We conclude from our study that, under well-controlled circumstances, it is feasible, efficacious, and safe to study acutely ill ICU patients for the purpose of diagnosing an underlying sleep disorder and treating the disorder appropriately. Early diagnosis and treatment of the underlying problem may lead to avoidance of endotracheal intubation and mechanical ventilation, and may lead to reductions in morbidity and length of stay in the ICU.

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