COCI

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 environment in the setting of critical care to improve patient outcome is comparatively new, and interest has resurfaced in the last two decades.

Together with our project partners ART+COM and GRAFT Architects we developed a new intensive care room concept to reduce patients' anxiety, helplessness, and stress. The patient's perceptions and needs were the starting point of this project. Besides the interventions aimed at noise shielding and the change of workflow, we conducted modifications to improve lighting conditions: One integral part of the room is a new light-ceiling for each bed that extends from the head above the patient down to the patients’ feet and covers an area of 15 square meters. Experimental data revealed sufficient circadian effective irradiance for melatonin suppression when applied in the critical care setting.

The purpose of the first prospective observational study was to investigate if mechanically ventilated patients treated in one of the new ICU rooms, have less delirium compared to patients treated in the standard rooms. We further evaluated the impact on sleep quality, circadian rhythmicity, global cognitive function and general outcome parameters.

The preliminary results of this cohort study revealed that the incidence of ICU delirium was significantly lower among patients treated in the modified rooms (46%) compared to patients treated in the standard rooms (76%). The main paper is currently under review and is expected to be published in early 2023.

In order to confirm the effect of light therapy on the circadian system of ICU patients, we are currently recruiting patients for a single-centre randomized controlled trial (HELIA-ICU, NCT05556811). Patients are randomized into three different treatment groups (LSA 1-3, Light Schedule Algorithm): Blue-Enriched Dynamic Light Application (LSA-1), Dynamic Light Application (LSA-2) and Standard Lighting (LSA-3). The circadian efficacy will be assessed by measuring serum melatonin levels every 4 hours for four 24-hour periods (SMAP 1-4, Serum Melatonin Assessment Period). SMAP 2 to 4 will be started only for patients with an adequate sedation status (Richmond Agitation Sedation Scale of -3 or above). We decided to include a blue-enriched light algorithm which is supposed to have even higher efficacy in terms of melatonin suppression. This RCT prepares for an upcoming multicenter RCT to ensure the most suitable lighting algorithms are being used. In the meantime, additional hospitals will equip their ICUs with the new light ceiling.