Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Australia.
Trials. 2024 Jun 11;25(1):376. doi: 10.1186/s13063-024-08222-6.
BACKGROUND: Intensive care medicine continues to improve, with advances in technology and care provision leading to improved patient survival. However, this has not been matched by similar advances in ICU bedspace design. Environmental factors including excessive noise, suboptimal lighting, and lack of natural lights and views can adversely impact staff wellbeing and short- and long-term patient outcomes. The personal, social, and economic costs associated with this are potentially large. The ICU of the Future project was conceived to address these issues. This is a mixed-method project, aiming to improve the ICU bedspace environment and assess impact on patient outcomes. Two innovative and adaptive ICU bedspaces capable of being individualised to patients' personal and changing needs were co-designed and implemented. The aim of this study is to evaluate the effect of an improved ICU bedspace environment on patient outcomes and operational impact. METHODS: This is a prospective multi-component, mixed methods study including a randomised controlled trial. Over a 2-year study period, the two upgraded bedspaces will serve as intervention beds, while the remaining 25 bedspaces in the study ICU function as control beds. Study components encompass (1) an objective environmental assessment; (2) a qualitative investigation of the ICU environment and its impact from the perspective of patients, families, and staff; (3) sleep investigations; (4) circadian rhythm investigations; (5) delirium measurements; (6) assessment of medium-term patient outcomes; and (7) a health economic evaluation. DISCUSSION: Despite growing evidence of the negative impact the ICU environment can have on patient recovery, this is an area of critical care medicine that is understudied and commonly not considered when ICUs are being designed. This study will provide new information on how an improved ICU environment impact holistic patient recovery and outcomes, potentially influencing ICU design worldwide. TRIAL REGISTRATION: ACTRN12623000541606. Registered on May 22, 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true .
背景：重症监护医学不断发展，技术和护理水平的进步提高了患者的生存率。然而，重症监护病房床位设计方面并没有取得类似的进步。环境因素，包括过度的噪音、不理想的照明以及缺乏自然光和景观，会对员工的健康和患者的短期和长期预后产生不利影响。由此带来的个人、社会和经济成本可能是巨大的。未来的重症监护病房项目就是为了解决这些问题而提出的。这是一个混合方法的项目，旨在改善重症监护病房的床位环境，并评估对患者结局的影响。两个具有创新性和适应性的重症监护病房床位能够根据患者的个人和不断变化的需求进行个性化设计，并进行了共同设计和实施。本研究的目的是评估改善重症监护病房床位环境对患者结局和运营影响的效果。
方法：这是一项前瞻性的多组分混合方法研究，包括一项随机对照试验。在为期 2 年的研究期间，这两个升级后的床位将作为干预床位，而研究重症监护病房中其余的 25 个床位将作为对照床位。研究内容包括：（1）客观环境评估；（2）从患者、家属和医护人员的角度对重症监护病房环境及其影响进行定性调查；（3）睡眠调查；（4）昼夜节律调查；（5）谵妄测量；（6）评估中期患者结局；（7）健康经济学评估。
讨论：尽管越来越多的证据表明重症监护病房环境对患者康复有负面影响，但这是重症监护医学领域一个研究不足的领域，在设计重症监护病房时通常不考虑这一点。本研究将提供有关改善重症监护病房环境如何影响整体患者康复和结局的新信息，可能会影响全球的重症监护病房设计。
试验注册：ACTRN12623000541606。于 2023 年 5 月 22 日注册。https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true。
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