Foot-Bathing Therapy Improved Sleeplessness in a Mechanically Ventilated Patient: A Case Report

Abstract

It is well known that sedation during mechanical ventilation should not be performed beyond the level necessary while being monitoring sedation status. However, some patients only complain of insomnia, even though the patient's degree of sedation has been assessed to be adequate. A woman aged 50 years with a history of systemic lupus erythematosus was transferred into our ICU with a diagnosis of respiratory infection. In 10 days treatment with antibacterial drug and mechanical ventilation improved her respiratory condition well enough to prepare for weaning from mechanical ventilation support. Her sedation was well managed such that a Richmond Agitation-Sedation Scale (RASS) score of ∁E to ∁E was achieved during treatment. In the process of ventilator weaning involved reducing her sedation gradually, targeting a RASS score of 0 to ∁E, she then began to complain of severe sleep disturbance. Neither ramelteon nor mianserin administration could improve her insomnia. Multidisciplinary discussion decided a trial of foot-bathing therapy for her sleep disorder. After starting warm footbath care during a daytime, her insomnia improved dramatically in a short time without additional medication or increasing the drug dosage. As the result, her extubation succeeded smoothly without delay.

Keywords

• sleep disorders in intensive care unit (icu)
• mechanical ventilation
• foot-bathing therapy