Modification of ICU environment is associated with reduced incidence of delirium
Preliminary results from the VITALITY study
Read the abstract

Delirium is the most frequent psychiatric syndrome in the Intensive Care Unit (ICU). This form of acute brain dysfunction predicts higher mortality rates and is associated with worse global cognitionafter ICU discharge. Therefore, delirium prevention bundles have become an integral part of guideline recommendations. Clinical trials investigating pharmacological strategies have failed to demonstrate consistent results in terms of patient outcomes. Hence, focus has moved towards non-pharmacological approaches.
Studies revealed that excessive deep sedation, even if restricted to initiation of ICU treatment, is one of the major independet risk factors for transitioning to delirium; everything should be done to avoid it.
However, a no-sedation approach is often challenging: ICU patients often suffer from symptoms of severe anxiety and agitation. One of the major reasons for the development of anxiety and agitation in critically ill patients is the ICU environment itself. The feelings of being surveyed all the time by monitors, being exposed to different kinds of machinery or equipment are reported to be major stressors.

Within an interdisciplinary project, we designed 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.
Beside interventions aimed at noise reduction, workflow optimisation and infection control, we developed a new light ceiling that enables clinicians to apply patient individualised light therapy. 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.After sample size calculation, 74 mechanically ventilated patients with an expected ICU length of stay >48 hours were included in this prospective cohort study. Amongst other reasons, patients with a substantial recent ICU exposure, patients who were unlikely to survive for 24 hours and patients who could not be reliably assessed for delirium were excluded from study participation. Delirium was assessed every 8 hours by research physicians with the Confusion Assessment Method for the ICU (CAM-ICU).
This study is the first to show that a modification in ICU environment is significantly associated with a reduced delirium incidence. Further analysis is needed to investigate which of the room interventions may contributed to this clinical effect.