Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study

ICU Design Working Group

doi:10.1097/CCM.0000000000006152

Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study

ICU Design Working Group

Klinik für Anästhesiologie und Intensivmedizin

Eberhard Karls Universität Tübingen

28 Zitate (Scopus)

Abstract

OBJECTIVES: Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed.

DESIGN: Prospective observational cohort pilot study.

SETTING: The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system.

PATIENTS: Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time.

CONCLUSIONS: Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.

Originalsprache	Englisch
Zeitschrift	Critical Care Medicine
Jahrgang	52
Ausgabenummer	4
Seiten (von - bis)	e182-e192
ISSN	0090-3493
DOIs	https://doi.org/10.1097/CCM.0000000000006152
Publikationsstatus	Veröffentlicht - 01.04.2024

Fördermittel

Dr. Luetz received funding from the Berlin Institute of Health Charité Clinician Scientist Program for conducting this study. Dr. Spies reports grants from the German Research Society, the German Aerospace Center, the Einstein Foundation Berlin, the Federal Joint Committee (G-BA), the Project Management Agency, the Non-Profit Society Promoting Science an Education, the European Society of Anaesthesiology and Intensive Care, Baxter Deutschland GmbH, Cytosorbents Europe GmbH, Edwards Lifesciences Germany GmbH, Fresenius Medical Care, Grünenthal GmbH, Masimo Europe Ltd., Pfizer Pharma PFE GmbH, Georg Thieme Verlag, Dr. F. Köhler Chemie GmbH, Sintetica GmbH, Philips Healthcare, Stiftung Charité, AGUETT ANT Deutschland GmbH, AbbVie Deutschland GmbH and KG, Amomed Pharma GmbH, lnTouch Health, Copra System GmbH, Correvio GmbH, Drägerwerk AG KGaA, the Max-Planck-Gesellschaft zur Förderung der Experiencing the risk of overutilizing opioids among patients with non-tumor chronic pain in ambulant care (ERONA) 2019–2021 Wissenschaften e.V., the Deutsche Gesellschaft für Anästhesiologie and lntensivmedizin and the Federal Ministry of Education and Research, outside the submitted work. Dr. Spies’ institution received funding from the Federal Ministry. Dr. Willemeit reports consulting fees from Trockland, Mercedes Benz, GSG Development, Hines Interests Limited Partnership and Signa Holding GmbH Development, outside the submitted work. Dr. Willemeit reports financial relationships with GRAFT Gesellschaft von Architekten mbH, GRAFT Designhaus GmbH and Graft GbR. Dr. Willemeit’s institution received funding from the German Ministry for Economic Research Funding (number KF2882602KJ2) and Charité Campus Virchow-Klinikum, Charité Facility Management; they disclosed relationships with Lighting Consultants LichtKunstLicht, Philips Lighting, and Art&Com; they received support for article research from the German Ministry for Economics Research Funding (number KF2882602KJ2). Dr. Luetz reports personal fees from Avanos Medical, Drägerwerk AG KGaA, Dr. Franz Köhler Chemie GmbH, Hill-Rom Holdings and Philips Healthcare outside the submitted work. He reports a grant from Philips Healthcare outside the submitted work which was paid into departmental funds and Charité Clinician Scientist Program. Drs. Spies (inventor), Willemeit (assignee), and Luetz (inventor) report issued patents related to the submitted work: European Patent 3 174 589 from July 31, 2015, European Patent 3 174 588 from July 31, 2015 and US Patent US 2017/0224950 A1 from August 10, 2017. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Träger	Trägernummer
Charite - Universitatsmedizin Berlin
Baxter Deutschland GmbH
Drägerwerk AG KGaA
Fresenius Medical Care North America
AbbVie Deutschland GmbH
Einstein Stiftung Berlin
Edwards Lifesciences Germany GmbH
Correvio GmbH
Bundesministerium für Bildung und Forschung
Philips Oral Healthcare
Deutsche Forschungsgemeinschaft
European Society of Anaesthesiology and Intensive Care
GRAFT Designhaus GmbH
AGUETT ANT Deutschland GmbH
Masimo Europe Ltd.
Stiftung Charité
Deutsche Gesellschaft für Anästhesiologie
Pfizer Pharma
CytoSorbents Europe
Köhler Chemie GmbH
Sintetica GmbH
German Ministry for Economic Research Funding	KF2882602KJ2
German Ministry for Economics Research Funding	3 174 589, 3 174 588, US 2017/0224950 A1

UN SDGs

Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung

SDG 3 – Gesundheit und Wohlergehen

DFG-Fachsystematik

2.22-12 Kardiologie, Angiologie

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10.1097/CCM.0000000000006152

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title = "Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study",

abstract = "OBJECTIVES: Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed.DESIGN: Prospective observational cohort pilot study.SETTING: The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system.PATIENTS: Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46\% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95\% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time.CONCLUSIONS: Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.",

author = "\{ICU Design Working Group\} and Claudia Spies and Helmut Piazena and Maria Deja and Klaus-Dieter Wernecke and Thomas Willemeit and Alawi Luetz",

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T1 - Modification in ICU Design May Affect Delirium and Circadian Melatonin

T2 - A Proof of Concept Pilot Study

AU - ICU Design Working Group

AU - Spies, Claudia

AU - Piazena, Helmut

AU - Deja, Maria

AU - Wernecke, Klaus-Dieter

AU - Willemeit, Thomas

AU - Luetz, Alawi

N1 - Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. Publisher Copyright: © 2024 Lippincott Williams and Wilkins. All rights reserved.

PY - 2024/4/1

Y1 - 2024/4/1

N2 - OBJECTIVES: Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed.DESIGN: Prospective observational cohort pilot study.SETTING: The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system.PATIENTS: Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time.CONCLUSIONS: Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.

AB - OBJECTIVES: Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed.DESIGN: Prospective observational cohort pilot study.SETTING: The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system.PATIENTS: Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time.CONCLUSIONS: Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.

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JO - Critical Care Medicine

JF - Critical Care Medicine

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Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study

Abstract

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