Circadian disruption of ICU patients: A review of pathways, expression, and interventions

Korompeli, Anna; Muurlink, Olav; Kavrochorianou, Nadia; Κατσούλας, Θεόδωρος; Fildissis, George; Baltopoulos, George

doi:10.1016/j.jcrc.2016.12.006

Cited by 54 publications

(40 citation statements)

References 116 publications

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“…Critically ill patients obviously benefit from the ability of clinicians to monitor and treat their conditions at all times of the day. Modern intensive care is characterized by a number of processes that can lead to circadian disruption including noise from monitors and staff, frequent waking for procedures and vital checks and light at night (Korompeli et al., 2017; Pulak & Jensen, 2016). Moreover, critically ill individuals may be particularly vulnerable to the unintended negative consequences of artificial lighting that occurs in the intensive care setting (Chan et al., 2012; Freedman, Gazendam, Levan, Pack, & Schwab, 2001; Nelson & DeVries, 2017).…”

Section: Introductionmentioning

confidence: 99%

Dim light at night exacerbates stroke outcome

Weil

Walker

Bumgarner

et al. 2020

Eur J of Neuroscience

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Circadian rhythms are endogenous biological cycles that synchronize physiology and behaviour to promote optimal function. These ~24‐hr internal rhythms are set to precisely 24 hr daily by exposure to the sun. However, the prevalence of night‐time lighting has the potential to dysregulate these biological functions. Hospital patients may be particularly vulnerable to the consequences of light at night because of their compromised physiological state. A mouse model of stroke (middle cerebral artery occlusion; MCAO) was used to test the hypothesis that exposure to dim light at night impairs responses to a major insult. Stroke lesion size was substantially larger among animals housed in dLAN after reperfusion than animals maintained in dark nights. Mice housed in dLAN for three days after the stroke displayed increased post‐stroke anxiety‐like behaviour. Overall, dLAN amplified pro‐inflammatory pathways in the CNS, which may have exacerbated neuronal damage. Our results suggest that exposure to LAN is detrimental to stroke recovery.

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Section: Introductionmentioning

confidence: 99%

Dim light at night exacerbates stroke outcome

Weil

Walker

Bumgarner

et al. 2020

Eur J of Neuroscience

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“…The internal states of patients in an intensive care unit (ICU), because of medication (sedation, opioids) and physiological parameters (organ dysfunction and failure), tend to result in distorted 24‐h rhythms (Paul and Lemmer, ; McKenna et al, ). On the other hand, external cycles (light, environmental noise, medical and nursing interventions) tend towards 24‐h activity (Weiss et al, ; Korompeli et al, ; McKenna et al, ). Artificial lighting afforded to patients, however, only loosely conforms to ‘normal’ light/dark cycles, and nursing rosters are structured to respond to staff availability and capability.…”

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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“…En las Unidades de Cuidados Intensivos (UCI), debido a sus características y a la elevada gravedad de sus pacientes, se incrementan las alteraciones del ritmo circadiano y del sueño, sufriendo deprivaciones tanto cualitativas como cuantitativas 3,4 . Estudios realizados sobre la incidencia de la alteración del sueño en el paciente crítico describen una prevalencia del 22% al 61%.…”

Section: Introductionunclassified

Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos

et al. 2021

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Introducción: Los pacientes críticos presentan frecuentes alteraciones del ritmo circadiano que modifican cualitativamente y cuantitativa la calidad del sueño. Objetivos: Describir la calidad del sueño e identificar los factores que la afectan. Pacientes y Método: Estudio observacional descriptivo y transversal realizado con una muestra de conveniencia de 129 pacientes. La diferencia entre los tres tiempos se realizó mediante la prueba de Wilcoxon y la correlación entre variables mediante la r de Spearman. Se realizaron análisis de regresión múltiple para relacionar las variables independientes con "calidad del sueño". Resultados: Los factores que más afectaron a la calidad del sueño fueron el ruido y la luz en los tres tiempos de forma constante, hubo diferencias entre los 3 tiempos para los cuidados (p=0,005) y actividades de enfermería (p=0,019). Mediante el modelo de regresión múltiple se encontró que otros factores que influían en la calidad del sueño eran la edad (p=0,012), la ingesta habitual de alcohol (p=0,023), la administración de benzodiacepinas en UCI (p=0,01) y la comorbilidad (p=0,005). Resultaron diferencias significativas en somnolencia entre el alta y primer día (p≤0,029), y entre alta y media estancia (p=0,001). Conclusiones: La somnolencia disminuyó al final de la estancia. Aunque el ruido y la luz fueron los factores más molestos, solo los cuidados y actividades de enfermería resultaron significativos. La edad, la ingesta habitual de alcohol, la administración de benzodiacepinas en UCI y un mayor índice de comorbilidad interfieren negativamente en la calidad del sueño.

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Circadian disruption of ICU patients: A review of pathways, expression, and interventions

Cited by 54 publications

References 116 publications

Dim light at night exacerbates stroke outcome

Dim light at night exacerbates stroke outcome

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

Factores que afectan a la calidad del sueño en las unidades de cuidados intensivos

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