Implementation and evaluation of the multidisciplinary “ABCDEF of sleep” protocol in Brazilian intensive care units: A quasi-experimental study. Results of a two-phase

INTRODUCTION: Sleep disruption is common in intensive care units (ICUs) and is associated with adverse outcomes. We evaluated whether a multidisciplinary sleep protocol improves subjective sleep quality in critically ill patients. METHODS: This multicenter quasi-experimental before-after study (2022-2024) was conducted in two Brazilian ICUs. Adult patients with an ICU stay of ≥2 nights were included. Sleep was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the ICU Questionnaire (SICUQ). Following baseline assessment, structured training and a multifaceted "ABCDEF of Sleep" protocol were implemented. The primary outcome was the global RCSQ score; secondary outcomes included SICUQ domains and clinical outcomes. RESULTS: A total of 112 patients were included (control = 61; intervention = 51). The primary outcome (aggregated 3-night RCSQ score) did not differ between groups (p = 0.31). In per-night analyses, RCSQ scores were higher on the second night in the intervention group (p = 0.008), with no differences on nights 1 or 3. The intervention improved perceived sleep quality and reduced environmental disturbances (p ≤ 0.001), without effects on mortality, mechanical ventilation, or length of stay. Family-reported sleep perception did not differ between groups. CONCLUSIONS: A pragmatic sleep protocol improved subjective sleep quality and reduced environmental disturbances in ICU patients, but did not impact major clinical outcomes. Larger studies using objective measures are needed.