Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Abstract

Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in “Post-ICU Syndrome” (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep–wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects. The main areas affected by most architectural and interior design modifications are sound environment, light control, floor planning, and room arrangement. Implementation of corresponding solutions is challenging considering the significant medical and technical demands of ICUs. This article discusses innovative concepts and promising approaches in ICU design that may be used to prevent stress and to support the healing process of patients, potentially limiting the impact of delirium and PICS.

Parvabumin interneuron-mediated hippocampal network activity disruption in a two-hit model with relevance to postintensive care syndrome: prevention by fluoxetine

“…It is important to point out that PICS is being increasingly recognized as a complication that affects more than 50% of critically ill patients, which has a profound impact on patients' lives, including reduced quality of life and increased mortality [1][2][3]. With improvements in healthcare and increased numbers of ICU survivors, PICS is likely to become more prevalent and will continue to be a public health issue [6]. Although PICS is a multidimensional concept, each component has been studied separately.…”

“…Chronic stress is one of the risk factors for the development of many neuropsychiatric diseases [5]. In patients admitted to ICU, they consistently face tremendous physical and psychological stressors, including social isolation, chemical and physical restraints, sleep disturbances due to exposure to noise and lights as well as other stressors [6,7]. An earlier study reported that nearly 50% of patients experience symptoms of depression, anxiety, post-traumatic stress disorder, and cognitive impairment, which may persist for years [8].…”

The Role of Daylight for Humans: Gaps in Current Knowledge

“…One study in seasonal affective disorder suggested outdoor light is equivalent in response [ 145 ]. We need to know if regular daylight exposure or mixed electric light/daylight (and darkness at night) enhances recovery/promotes health in hospitalised patients more efficiently (e.g., post-surgery, intensive care [ 149 , 150 , 151 ]), and in healthcare institutions (e.g., psychiatric wards, nursing homes [ 152 , 153 ]) than with electric light alone. The question arises as to which daylight interventions are needed for which groups (e.g., patients with impaired vision/visual blindness, circadian rhythm sleep–wake disorders, depression and other psychiatric/neurologic diagnoses), adolescents or older people, shift workers, men and women?…”

Proposal for an Implementation Framework for Digital Health Technology in the Intensive Care Unit: A Qualitative Study

“…In the decades to come, health care providers will experience the need to implement new digital health technology into their infrastructures [56,[59][60][61]. They will necessitate to be abreast of the latest digital health technologies, to select the appropriate technology for the speci c area of application, and to plan and execute the implementation process, requiring an effective and e cient approach to implementation.…”