Anderson Diana C, Warner Paige E, Smith Matthew R, Albanese Marissa L, Mueller Ariel L, Messervy John, Renne B Christian, Smith Samuel J
Department of Neurology, Boston University, Boston, MA.
Jacobs Solutions, Boston, MA.
Crit Care Med. 2025 Mar 1;53(3):e590-e599. doi: 10.1097/CCM.0000000000006557. Epub 2025 Jan 8.
The ICU built environment-including the presence of windows-has long been thought to play a role in delirium. This study investigated the association between the presence or absence of windows in patient rooms and ICU delirium.
Retrospective single institution cohort study. Delirium was assessed with the Confusion Assessment Method for the ICU.
ICU patients between January 1, 2020, and September 1, 2023, were categorized into windowed or nonwindowed groups based on their ICU room design. The primary outcome was the presence or absence of delirium at any time during the patient's ICU stay. Secondary outcomes included the presence of delirium during the first 7 days of the ICU stay, hospital length of stay, ICU length of stay, in-hospital mortality, pain scores, and Richmond Agitation-Sedation Scale scores.
None.
A total of 3527 patient encounters were included in the final analysis, of which 1292 distinct patient encounters were admitted to a room without windows (37%). Delirium was observed in 21% of patients (460/2235) in windowed rooms and 16% of patients (206/1292) in nonwindowed rooms. In adjusted analyses, patients in windowed rooms were associated with an increase in the odds of the presence of delirium (odds ratio, 1.29; 95% CI, 1.07-1.56; p = 0.008). Patients in windowed rooms were found to have longer hospital (adjusted hazard ratio [aHR], 0.94; 95% CI, 0.87-1.00) and ICU length of stay (aHR, 0.93; 95% CI, 0.87-1.00) compared with patients in the nonwindowed rooms, although this was not statistically significant in adjusted analyses ( p = 0.06 and 0.05, respectively). No statistically significant difference was observed in other secondary outcomes.
The current study provides insightful information regarding associations between a component of the ICU built environment, specifically the presence or absence of windows, and the frequency of delirium.
重症监护病房（ICU）的建筑环境，包括窗户的有无，长期以来一直被认为与谵妄有关。本研究调查了病房中有无窗户与ICU谵妄之间的关联。
回顾性单机构队列研究。采用ICU意识模糊评估方法评估谵妄。
2020年1月1日至2023年9月1日期间的ICU患者，根据其ICU病房设计分为有窗组或无窗组。主要结局是患者在ICU住院期间任何时间是否发生谵妄。次要结局包括ICU住院前7天内谵妄的发生情况、住院时间、ICU住院时间、院内死亡率、疼痛评分和里士满躁动镇静量表评分。
无。
最终分析共纳入3527例患者，其中1292例不同患者入住无窗病房（37%）。有窗病房中21%的患者（460/2235）和无窗病房中16%的患者（206/1292）发生了谵妄。在调整分析中，有窗病房的患者发生谵妄的几率增加（比值比，1.29；95%CI，1.07-1.56；p=0.008）。与无窗病房的患者相比，有窗病房的患者住院时间（调整后风险比[aHR]，0.94；95%CI，0.87-1.00）和ICU住院时间（aHR，0.93；95%CI，0.87-1.00）更长，尽管在调整分析中这无统计学意义（分别为p=0.06和0.05）。在其他次要结局中未观察到统计学显著差异。
本研究提供了关于ICU建筑环境的一个组成部分，特别是窗户的有无，与谵妄发生频率之间关联的有价值信息。
