Evaluation of a New ICU Environment
VITALITY, A prospective observational cohort study
Published
Delirium is one of the most frequently seen brain organ dysfunctions in the intensive care unit (ICU). Depending on the ICU population, up to 87% have delirium at some point during their critical illness. Patients with delirium have a 3fold increased risk of dying compared to patients without delirium.
Studies show that sedation is one of the most common independent risk factors for transitioning to delirium. However, a no-sedation approach is often challenging: ICU patients often suffer from symptoms of severe anxiety and agitation. One of the primary reasons for the development of anxiety and agitation in critically ill patients is the ICU environment itself. The feelings of being constantly surveyed by monitors and being exposed to different machinery or equipment are significant stressors.
Together with our project partners ART+COM and GRAFT Architects we developed a ICU 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 patient's feet and covers an area of 15 square meters.
“… But what I see these days are paralyzed, sedated patients, lying without motion, appearing to be dead, except for the monitors that tell me otherwise.”
The purpose of the prospective proof of concept pilot study was to investigate if a multicomponent change in ICU room design, including light therapy, prevents delirium in mechanically ventilated patients. Second, the influence of lighting conditions on serum melatonin was assessed. Additional information regarding the study protocol can also be found at ClinicalTrials.gov. 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.
Study Flow Diagram. 0, day of patient enrollment; SMAP, Serum Melatonin Assessment Period (A, 1st day of intervention; B, 3rd day of intervention or later; C, 5th day of intervention or later.); SCP, Sedation Check Period; RASS, Richmond Agitation Sedation Scale. Numbers in yellow squares indicate the time of blood plasma collection for melatonin assessment (e.g., 8 = 08:00 in the morning). Figure published in Critical Care Medicine
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.
In conclusion, modifications in ICU room design may reduce delirium, where dedicated light therapy potentially contributed to differences in outcome. For additional key information and figures regarding the study results, kindly visit our blog post.
This year's Day of Intensive Care Medicine was held under the motto Zurück ins Leben — "Back to Life." The panel deliberately shifted the focus away from devices, numbers, and waveforms and toward the people who actually experience critical care: patients, their families, and the interprofessional teams who accompany them.
At the center of the discussion was the story of Cornelia Sichermann, who survived life-threatening sepsis and spent six months in hospital before finding her way back into everyday life. She was joined by a family member and by colleagues from medicine, nursing, and psychology — a constellation that made visible how differently the same intensive care unit is perceived from the bed, from the bedside chair, and from the professional side of the room.
The excerpt we are publishing here concentrates on one thread of that conversation: how intensive care units and patient rooms are designed, and why that design is a clinical variable rather than an aesthetic afterthought.
The cholinergic system is pivotal in cognitive processes, sleep regulation, and inflammatory responses, particularly in critically ill patients. Delirium, a common complication in intensive care units (ICUs), is often linked to disturbances in the cholinergic system, with serum cholinesterase activities as potential biomarkers. Results published by our research group suggest that environmental factors, such as lighting, can influence circadian melatonin rhythms and potentially mitigate delirium. The following data analysis explores how modifications in ICU design, specifically incorporating dynamic light therapy, impact the oscillation of serum acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activities in critically ill patients, which play crucial roles in the cholinergic system and have been linked to cognitive function and delirium in critically ill patients.
Patient care in the Intensive Care Unit (ICU) inevitably takes place around the clock. As a result, the contrast between day and night, which is so pervasive and prominent outside the hospital, is virtually absent in the ICU. Moreover, organ support and supportive care are typically administered with little regard to the time of day. Despite such care activities being critical for patients, these conditions provide weak and conflicting timing cues to the circadian clock, the endogenous biological timekeeper that serves to optimally synchronize 24-hour rhythms in behavior and physiology.
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.
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. In 2013 we finished the renovation of 2 double ICU rooms. We hypothesised that the delirium incidence for patients treated in the modified rooms is significantly lower when compared to patients treated in the standard rooms.
Our working group has just evaluated photometric parameters of three different electric light sources in the ICU, including the newly developed, 15 square meters large LED light-ceiling. Furthermore, we aimed at estimating potential circadian efficacy and side effects of the investigated light sources for exposed ICU patients.
Dr. Adam Gazzaley, a neuroscientist at the University of California in San Francisco designed NeuroRacer, a game for older adults in which they respond to traffic signs that appear suddenly while driving on a winding road. The game enhanced cognitive control in subjects ranging from 60 to 85, according to a study published in Nature.
Das Beatmungsgerät klingt nach Darth Vader, der Pulsmesser piepst - und irgendwo geht schon wieder gellend der Alarm los. Alltag auf einer Intensivstation, deren hektisch-nervöse Atmosphäre schon Gesunde einschüchtern kann. An der Berliner Charité sehen zwei Krankenzimmer nun völlig anders aus.