Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands; Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands.
Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
Lancet Respir Med. 2016 Mar;4(3):194-202. doi: 10.1016/S2213-2600(16)00025-4. Epub 2016 Feb 16.
Disturbed circadian rhythm is a potentially modifiable cause of delirium among patients in intensive-care units (ICUs). Bright-light therapy in the daytime can realign circadian rhythm and reduce the incidence of delirium. We investigated whether a high-intensity dynamic light application (DLA) would reduce ICU-acquired delirium.
This was a randomised, controlled, single-centre trial of medical and surgical patients admitted to the ICU of a teaching hospital in the Netherlands. Patients older than 18 years, expected to stay in the ICU longer than 24 h and who could be assessed for delirium were randomised to DLA or normal lighting (control), according to a computer-generated schedule. The DLA was administered through ceiling-mounted fluorescent tubes that delivered bluish-white light up to 1700 lux between 0900 h and 1600 h, except for 1130-1330 h, when the light was dimmed to 300 lux. The light could only be turned off centrally by investigators. Control light levels were 300 lux and lights could be turned on and off from inside the room. The primary endpoint was the cumulative incidence of ICU-acquired delirium. Analyses were by intention to treat and per protocol. The study was terminated prematurely after an interim analysis for futility. This study is registered with Clinicaltrials.gov, number NCT01274819.
Between July 1, 2011, and Sept 9, 2013, 734 patients were enrolled, 361 in the DLA group and 373 in the control group. Delirium occurred in 137 (38%) of 361 DLA patients and 123 (33%) of 373 control patients (odds ratio 1·24, 95% CI 0·92-1·68, p=0·16). No adverse events were noted in patients or staff.
DLA as a single intervention does not reduce the cumulative incidence of delirium. Bright-light therapy should be assessed as part of a multicomponent strategy.
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昼夜节律紊乱是 ICU 患者发生谵妄的一个潜在可改变的原因。白天进行亮光疗法可以调整昼夜节律，降低谵妄的发生率。我们研究了高强度动态光照（DLA）是否会降低 ICU 获得性谵妄。
这是一项在荷兰一所教学医院 ICU 中进行的随机、对照、单中心试验，纳入了成年患者。患者年龄大于 18 岁，预计 ICU 停留时间超过 24 h，并且可以评估谵妄。根据计算机生成的时间表，患者被随机分配至 DLA 或常规光照（对照组）。DLA 通过天花板安装的荧光灯管提供，在 09:00 至 16:00 之间提供高达 1700 勒克斯的蓝白色光，但 11:30 至 13:30 除外，此时灯光调暗至 300 勒克斯。只有调查人员可以集中关闭灯光。对照光照水平为 300 勒克斯，灯光可以从房间内打开和关闭。主要终点是 ICU 获得性谵妄的累积发生率。分析按意向治疗和方案进行。在进行无效性中期分析后，提前终止了研究。这项研究在 Clinicaltrials.gov 注册，编号为 NCT01274819。
在 2011 年 7 月 1 日至 2013 年 9 月 9 日期间，共纳入了 734 名患者，361 名患者分配至 DLA 组，373 名患者分配至对照组。DLA 组中 137 名（38%）和对照组中 123 名（33%）患者发生了谵妄（比值比 1.24，95%CI 0.92-1.68，p=0.16）。患者或工作人员均未出现不良反应。
DLA 作为单一干预措施并不能降低谵妄的累积发生率。强光疗法应作为多组分策略的一部分进行评估。
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