Delirium is a common psychiatric syndrome among critically ill patients, which is linked to a higher risk of mortality. Although pharmacological interventions have not shown significant benefits, non-pharmacological approaches have gained attention. The Society of Critical Care Medicine recommends a comprehensive intervention bundle to manage pain, agitation, delirium, immobility, and sleep disruption.


A study published in Critical Care Medicine has concluded that modifications in ICU room design and dedicated light therapy may affect the incidence and severity of delirium by modulating circadian melatonin levels.
Current guidelines recommend Nonpharmacologic delirium management, but data regarding the impact of ICU design remain limited. The study determined if a multicomponent change in room design prevents ICU delirium. Researchers in this study also assessed the influence of lighting conditions on serum melatonin in their prospective observational cohort pilot study.
A new design concept was established in two two-bed ICU rooms in a university hospital, including stress-relief modifications and dynamic lighting. Seventy-four adult critically ill patients on mechanical ventilation with a 48-hour minimum ICU stay were treated in modified or standard rooms.
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.
Key findings are:
The analysis had Seventy-four patients.
Twenty-eight patients (76%) in the standard rooms developed delirium than 17 patients (46%)in the modified rooms.
The light-emitting area of each dynamic lighting system (DLS) covered a surface of up to 6.1 m × 2.4 m for one ICU bed.
When compared to modified rooms, Patients in standard rooms had a 2.3-fold higher delirium severity with an odds ratio of 2.292.
Light intensity significantly influenced the course of serum melatonin.
Serum melatonin differences between patients in standard and modified rooms were different over time showing variations in specific periods.
Light intensity differences between standard and modified ICU rooms impacted patients' melatonin patterns. Modifying room design may reduce delirium.
This study provided evidence on the effectiveness of nonpharmacologic strategies in managing delirium. Integrating a DLS with adequate light intensity into the room could potentially impact delirium outcomes in critically ill patients by modulating circadian melatonin rhythms.
Reference:
Spies, et al. ICU Design Working Group. Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study. Critical Care Medicine ():10.1097/CCM.0000000000006152, December 19, 2023. | DOI: 10.1097/CCM.0000000000006152