Light Levels in ICU Patient Rooms: Dimming of Daytime Light in Occupied Rooms

Lusczek, Elizabeth R.; Knauert, Melissa P.

doi:10.1177/23743735211033104

Cited by 12 publications

(12 citation statements)

References 18 publications

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“…In the hospital setting, the impact of light on patient outcomes has been extensively studied and alterations to the design of facilities to better support healthy sleep have been proposed and successfully implemented ( Acosta et al, 2017 ; Vethe et al, 2021 ). Light exposure to ill patients has a duality of effects: outcomes improve with more natural light during the day ( Park et al, 2018 ; Lusczek and Knauert, 2021 ) but light can have detrimental effects if presented at night ( Craig and Mathieu, 2018 ; Albala et al, 2019 ). Currently the literature lauded the circadian system as the main perpetrator of these risks and benefits; however, masking is also key to promoting these immediate effects of light on sleep.…”

Section: Sleep Disturbances and Maskingmentioning

confidence: 99%

Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways

Gall

Shuboni-Mulligan

2022

Front. Neurosci.

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Environmental cues (e.g., light-dark cycle) have an immediate and direct effect on behavior, but these cues are also capable of “masking” the expression of the circadian pacemaker, depending on the type of cue presented, the time-of-day when they are presented, and the temporal niche of the organism. Masking is capable of complementing entrainment, the process by which an organism is synchronized to environmental cues, if the cues are presented at an expected or predictable time-of-day, but masking can also disrupt entrainment if the cues are presented at an inappropriate time-of-day. Therefore, masking is independent of but complementary to the biological circadian pacemaker that resides within the brain (i.e., suprachiasmatic nucleus) when exogenous stimuli are presented at predictable times of day. Importantly, environmental cues are capable of either inducing sleep or wakefulness depending on the organism’s temporal niche; therefore, the same presentation of a stimulus can affect behavior quite differently in diurnal vs. nocturnal organisms. There is a growing literature examining the neural mechanisms underlying masking behavior based on the temporal niche of the organism. However, the importance of these mechanisms in governing the daily behaviors of mammals and the possible implications on human health have been gravely overlooked even as modern society enables the manipulation of these environmental cues. Recent publications have demonstrated that the effects of masking weakens significantly with old age resulting in deleterious effects on many behaviors, including sleep and wakefulness. This review will clearly outline the history, definition, and importance of masking, the environmental cues that induce the behavior, the neural mechanisms that drive them, and the possible implications for human health and medicine. New insights about how masking is affected by intrinsically photosensitive retinal ganglion cells, temporal niche, and age will be discussed as each relates to human health. The overarching goals of this review include highlighting the importance of masking in the expression of daily rhythms, elucidating the impact of aging, discussing the relationship between dysfunctional masking behavior and the development of sleep-related disorders, and considering the use of masking as a non-invasive treatment to help treat humans suffering from sleep-related disorders.

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Section: Sleep Disturbances and Maskingmentioning

confidence: 99%

Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways

Gall

Shuboni-Mulligan

2022

Front. Neurosci.

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“…These simple interventions have the potential to improve patient sleep and circadian rhythms, reducing light and sound exposure. “New care ICU bundles” include patient-related issue, provider-related barriers, protocol-related barriers, and ICU contextual barriers 30-33 . A recent meta-analysis of interventions showed that limiting patient exposure to noise and disturbance using earplugs and eye masks have been shown to reduce the risk of delirium 34 …”

Section: Discussionmentioning

confidence: 99%

Sound and Light Levels in a General Intensive Care Unit Without Windows to Provide Natural Light

Lucchini

Giani

Ferrari

et al. 2023

Dimens Crit Care Nurs

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Background: Appropriate levels and patterns of sound and light in an intensive care room help to maintain the patient's normal physiological functions. High sound levels can disrupt the patient's normal sleep architecture, cause hearing deficits, and induce the onset of delirium. Intensive care unit patients frequently report poor sleep, partly due to the environment.Objectives: An observational pilot prospective study was designed to record sound pressure and light pollution levels in an Italian intensive care unit, without windows to provide natural light.Method: Sound levels were measured in decibel A (dBA) every 10 seconds. Sound data were analyzed for sound peak, defined as the number of times sound levels exceeded 45, 50, 60, 65, 70, 75, 80, and 85 dBA. Light measures were taken every 10 seconds on a continuous basis. Light data were analyzed for light "peaks," defined as the number of times light levels exceeded 100, 200, 300, 400, and 500 lux.Results: The overall median sound level during the study period was equal to 54.60 (interquartile range [IQR], 51.70-57.70) dBA. The daytime median sound level was 56.00 (IQR, 53.00-59.50) dBA, and the nighttime median was 53.00 (IQR,) dBA ( P < .001). The overall median light level was equal to 114 (IQR, 0-225) lux. The daytime median light level was 184 (IQR, 114-293) lux, and the nighttime median was 0 (IQR, 0-50) lux ( P < .001). With respect to room lighting, rooms were observed to have "no lights on" 12.6% of daytime and 41% of nighttime.Discussion: The sound levels recorded in our sample demonstrated that peaks >45 dBA during daytime and nighttime are, respectively, equal to 99.9% and 98.6% of all readings. The Environmental Protection Agency/World Health Organization recommended thresholds for both day (45 dBA) and night (35 dBA). Sound levels reached "toxic levels" when sound-generating activities were performed by nurses and physicians.

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“…The circadian rhythm is affected by external stimuli, and critically ill patients commonly experience disrupted physiological circadian rhythms. Potential factors contributing to alterations in circadian rhythmicity in neuroICU patients include nocturnal light exposure, noise, altered feeding schedules, disease severity, scheduled nursing care, and sedative medications [22][23][24]. Therefore, pupil dynamics in the neuroICU may have been affected by the neuroICU environment influencing the patients' circadian rhythms [18,19,[22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Diurnal variation in quantitative pupillary reactivity in large hemispheric stroke

Kim,

Lee,

Park

et al. 2023

J Neurocrit Care

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Background: Pupillary light reflex (PLR) assessment is an important neurological examination reflecting neurological deterioration in severe stroke cases. This study investigated the impact of diurnal variation in the PLR using quantitative pupillometry in stable patients with large hemispheric stroke.Methods: We included 35 patients with large hemispheric stroke without neurological worsening, who were admitted to the neurological intensive care unit between April 2017 and November 2021. Quantitative pupillometry was performed every 4 hours. Pupillometer parameters of maximum pupil size, percentage of constriction (%CH), latency (LAT), constriction velocity (CV), dilation velocity (DV), maximum constriction velocity (MCV), and neurological pupil index (NPi) score were recorded. We evaluated changes in the pupillometer parameters over time using linear mixed model analysis.Results: The diurnal variations revealed that the following parameters were significantly higher at 04:00 than at 20:00: maximum pupil size (right [Rt]: 3.59 vs. 3.21 mm, P<0.001; left [Lt]: 3.51 vs. 3.18 mm, P<0.001), %CH (Rt: 31.48 vs. 25.72, P<0.001; Lt: 31.42 vs. 24.98, P<0.001), CV (Rt: 1.97 vs. 1.68 mm/sec, P<0.001; Lt: 1.98 vs. 1.65 mm/sec, P<0.001), and DV (Rt: 0.97 vs. 0.84 mm/sec, P<0.001; Lt: 0.94 vs. 0.82 mm/sec, P=0.001). However, no significant diurnal variations were observed in the NPi values. Conclusion: Pupillary dynamics based on quantitative pupillometer parameters, including the NPi, demonstrated diurnal variations over 24 hours in large hemispheric stroke patients without neurological worsening. However, all changes in the pupillometer parameters were within normal ranges.

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Light Levels in ICU Patient Rooms: Dimming of Daytime Light in Occupied Rooms

Cited by 12 publications

References 18 publications

Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways

Keep Your Mask On: The Benefits of Masking for Behavior and the Contributions of Aging and Disease on Dysfunctional Masking Pathways

Sound and Light Levels in a General Intensive Care Unit Without Windows to Provide Natural Light

Diurnal variation in quantitative pupillary reactivity in large hemispheric stroke

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