Bright light treatment for prevention of perioperative delirium in elderly patients

Taguchi, Toyoe

doi:10.5430/jnep.v3n10p10

Cited by 11 publications

(13 citation statements)

References 12 publications

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“…Bright light treatment during daytime has been found to adjust sleep–wakefulness cycles and reduce postoperative delirium (Taguchi et al, ; Ono et al, ; Taguchi, ; Simons et al, ). On the other hand, light at night (LAN) affects the circadian system, diminishes light/dark (L/D) differences and can be harmful to other physiological systems (Fonken and Nelson, ; Gaston et al, ).…”

Section: Introductionmentioning

confidence: 99%

Light affects heart rate's 24‐h rhythmicity in intensive care unit patients: an observational study

Korompeli

Kavrochorianou

Molčan

et al. 2019

Nursing in Critical Care

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Background Intensive care unit (ICU) patients experience two affronts to normal 24‐h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions. Aims and objectives We investigated the impact of light variance within an ICU on 24‐h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population. Design Patients were assigned to beds either in the ‘light’ or ‘dark’ side within a single ICU. An actigraph continuously recorded light intensity for a 24–72‐h period. Methods Measurements of HR, MAP and BT were recorded every 30 min. Results HR, MAP and BT did not follow 24‐h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147). Conclusions ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24‐h rhythm of HR. Larger, well‐controlled studies also investigating the effect of relevant light intensity are indicated. Relevance to clinical practice Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions.

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Section: Introductionmentioning

confidence: 99%

Light affects heart rate's 24‐h rhythmicity in intensive care unit patients: an observational study

Korompeli

Kavrochorianou

Molčan

et al. 2019

Nursing in Critical Care

View full text Add to dashboard Cite

show abstract

“…Although the underlying causal relationship between circadian rhythm and delirium remains unknown, the general assumption is that maintenance of the biological clock, thereby promoting normal sleep-wake cycles, can reduce the chances of developing ICU delirium. However, BLT’s beneficial effects for ICU patients have largely derived from studies primarily with non-critically ill patients [ 8 , 22 ]. As direct causal relation between disturbed sleep-wake cycles and delirium have not been fully substantiated, it is possible that both pathologies are a result of systemic and central nervous system inflammation commonly associated with a number of disorders including trauma and sepsis [ 23 ] The process involves the coordinated release of proinflammatory mediators and systemic cytokines during the acute phase of an illness that can dramatically alter the scope and character of brain injury.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Controlled Pilot Study of High-Intensity Lightbox Phototherapy to Prevent ICU-Acquired Delirium Incidence

Zhang¹,

Pelleg²,

Hussain³

et al. 2021

Cureus

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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.

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“…Despite being a small, pilot study, the results demonstrate the feasibility of a simple intervention to restore proper rhythmic characteristics of the central clock in ICU patients. Interestingly, morning light exposure has been shown to positively impact delirium in three out of five studies ( 38 – 42 ) suggesting that this treatment may improve not just circadian rhythmicity, but also a medical problem that is common in ICU patients.…”

Section: Circadian Rhythm Restoration To Improve Outcomementioning

confidence: 99%

Circadian Disruption in Critical Illness

et al. 2020

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Circadian rhythms play a vital role in metabolic, hormonal, and immunologic function and are often disrupted in patients in the ICU. Circadian rhythms modulate the molecular machinery that responds to injury and illness which can impact recovery. Potential factors contributing to the alteration in circadian rhythmicity in intensive care unit (ICU) patients include abnormal lighting, noise, altered feeding schedules, extensive patient care interactions and medications. These alterations in circadian rhythms in ICU patients may affect outcomes and therefore, normalization of circadian rhythmicity in critically ill patients may be an important part of ICU care.

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Bright light treatment for prevention of perioperative delirium in elderly patients

Cited by 11 publications

References 12 publications

Light affects heart rate's 24‐h rhythmicity in intensive care unit patients: an observational study

Light affects heart rate's 24‐h rhythmicity in intensive care unit patients: an observational study

Prospective Randomized Controlled Pilot Study of High-Intensity Lightbox Phototherapy to Prevent ICU-Acquired Delirium Incidence

Circadian Disruption in Critical Illness

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