Zhang Kermit S, Pelleg Tomer, Hussain Shahzad, Kollipara Venkateswara, Loschner Anthony, Foroozesh Mahtab B, Rubio Edmundo, Biscardi Frank, Ie Susanti R
Pulmonary, Critical Care and Sleep Medicine Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA.
Critical Care Medicine, Samaritan Medical Center, Portland, USA.
Cureus. 2021 Apr 1;13(4):e14246. doi: 10.7759/cureus.14246.
Background This study aimed to evaluate the role of disturbed circadian rhythm in potentiating intensive care unit (ICU)-acquired delirium.Previous studies have demonstrated bright light therapy (BLT) as an effective modality to improve sleeping patterns and cognitive function in non-critically ill patients. However, its benefit in the ICU has not been clearly established. In this study, we aimed to evaluate the application of daily high-intensity phototherapy at the bedside to deter ICU delirium incidence and duration. Methodology This was a single center, prospective study conducted in ICUs at the Carilion Roanoke Memorial Hospital in Roanoke, VA. Adults patients admitted to the ICU from July 9, 2018 to March 20, 2020 were included in the study. The patients were subjected to 30-minute BLT session (10,000 lux) at the bedside starting at 0700 while in the ICU. Patients were randomized into either the control group (standard hospital lighting) or phototherapy group. Data were analyzed using Wilcoxon rank sum test for continuous variables, Pearson chi-square test for categorical variables, and logistic regression for multivariable analysis that examined significant risk factors for ICU delirium. Results Delirium incidence between BLT (18%) and control (17.5%) groups was non-significant. Total number of delirium-free, coma-free days, as determined by Confusion Assessment Method for the ICU, demonstrated no differences between groups with a median of 28 days (p = 0.516). In multivariable analysis, patients with a Sequential Organ Failure Assessment Score >3 also showed no significant change in ICU delirium incidence when provided bedside BLT compared to those with standard hospital lighting (odds ratio: 0.08; 95% confidence interval: 0.002-1.40; p = 0.867). Conclusions In this randomized control pilot study, daily morning 10,000 lux BLT of 30-minute duration alone was not associated with a significant decrease in ICU-acquired delirium incidence or duration compared to standard hospital lighting. Future studies should consider a nuanced approach to better elucidate the role of disturbed circadian rhythm in influencing ICU-acquired delirium by not only undertaking BLT during the day but also minimizing nighttime light exposure.
背景 本研究旨在评估昼夜节律紊乱在强化重症监护病房（ICU）获得性谵妄中的作用。以往研究表明，强光疗法（BLT）是改善非危重症患者睡眠模式和认知功能的有效方法。然而，其在ICU中的益处尚未明确确立。在本研究中，我们旨在评估在床边每日进行高强度光疗对降低ICU谵妄发生率和持续时间的作用。
方法 这是一项在弗吉尼亚州罗阿诺克市卡里利恩罗阿诺克纪念医院的ICU进行的单中心前瞻性研究。纳入2018年7月9日至2020年3月20日入住ICU的成年患者。患者在ICU期间，于0700开始在床边接受30分钟的BLT治疗（10000勒克斯）。患者被随机分为对照组（标准医院照明）或光疗组。对连续变量使用Wilcoxon秩和检验进行数据分析，对分类变量使用Pearson卡方检验，对多变量分析使用逻辑回归来检查ICU谵妄的显著危险因素。
结果 BLT组（18%）和对照组（17.5%）之间的谵妄发生率无显著差异。根据ICU意识模糊评估方法确定的无谵妄、无昏迷天数，两组之间无差异，中位数为28天（p = 0.516）。在多变量分析中，序贯器官衰竭评估评分>3的患者，与接受标准医院照明的患者相比，在床边接受BLT时，ICU谵妄发生率也无显著变化（比值比：0.08；95%置信区间：0.002 - 1.40；p = 0.867）。
结论 在这项随机对照试验研究中，与标准医院照明相比，仅每日早晨进行30分钟、10000勒克斯的BLT与ICU获得性谵妄的发生率或持续时间显著降低无关｡未来的研究应考虑采用细致入微的方法，不仅要在白天进行BLT，还要尽量减少夜间光照暴露，以更好地阐明昼夜节律紊乱在影响ICU获得性谵妄中的作用｡
