The concept of the medical environment as an influential factor in shaping how patients experience their illness and eventual outcome has long been part of clinical medicine. Nevertheless, the notion of reshaping the intensive care unit (ICU) environment to improve patient outcomes is comparatively new, and interest has resurfaced in the last two decades. Together with our project partners ART+COM and GRAFT Architects, we developed an ICU room concept to reduce patients' anxiety, helplessness, and stress. The patient's perceptions and needs were the starting point of this project. The new design concept was established in two two-bed ICU rooms at the Charité University Hospital.
Delirium severity: relative effects from scoring results with the intensive care delirium screening checklist (ICDSC) between patients in standard (grey) and modified (purple) rooms. Figure published in Critical Care Medicine
We are thrilled to share that the first comprehensive research paper with data from the VITALITY study has been published in Critical Care Medicine. In this prospective observational cohort pilot study, we compared the outcome of 74 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.
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 treated in standard rooms had a 1.7-fold increased risk of developing delirium compared with patients treated in the modified rooms (odds ratio [OR] = 1.65; 95% CI, 1.12–2.41). Delirium severity was significantly lower for patients treated in modified compared with patients in standard rooms (0 [interquartile range, IQR, 0–2] vs. 3 [IQR, 1–4], p < 0.0001).
Patients in standard rooms had a 2.3-fold higher delirium severity than those in modified rooms (OR = 2.292; 95% CI, 1.582–3.321).
Furthermore, MANOVA for delirium severity showed a statistically significant difference between groups (p < 0.0001) with higher ICDSC scores for patients in standard rooms.
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.
Relative effect sizes of serum melatonin levels under the influence of circadian effective irradiance (CEI). SMAP = serum melatonin assessment period, SMAP-A = first day of intervention, SMAP-B = third day of intervention or later, SMAP-C = fifth day of intervention or later. Figure published in Critical Care Medicine
In conclusion, modifications in ICU room design may reduce delirium, where dedicated light therapy potentially contributed to differences in outcome. For further insights about the study and access to the full paper, kindly visit our dedicated webpage.