Natural versus artificial light exposure on delirium incidence in ARDS patients

Vahedian‐Azimi, Amir; Bashar, Farshid Rahimi; Khan, Abbas M; Miller, Andrew C.

doi:10.1186/s13613-020-0630-8

Cited by 11 publications

(15 citation statements)

References 8 publications

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“…The median time to ICU delirium onset was similar to other published studies [61,62]. Moreover, the seven variables identi ed on Cox regression analysis were similar to other published reports [60,63,64] [26,[65][66][67]. The connection of NL vs. AL light exposure and delirium incidence has been variably reported [26,[68][69][70].…”

Section: Discussionsupporting

confidence: 87%

“…Moreover, the seven variables identi ed on Cox regression analysis were similar to other published reports [60,63,64] [26,[65][66][67]. The connection of NL vs. AL light exposure and delirium incidence has been variably reported [26,[68][69][70]. This discrepancy may be related to differences in delirium de nition, screening method, NL category criteria, and sample size [26].…”

Section: Discussionsupporting

confidence: 83%

“…Both ICUs had the same geographic layout including 10 beds; 5 with adjacent windows allowing for NL (circadian pattern), and 5 positioned 13 m from the nearest window receiving only AL. Patients were categorized according to their original bed locations as NL and AL groups [26].…”

Section: Natural Vs Arti Cial Lightmentioning

confidence: 99%

“…Patient-related factors include: age, gender, underlying disease, baseline cognitive impairment, illness severity (measured as Acute Physiology and Chronic Health Evaluation (APACHE) IV score), and presence of deliriumatadmission. Hospital-related factors include medications (including sedatives), nursing care, staffburnout and turnover, mechanical ventilation (MV), non-ICU hospital or ICU LOS, isolation, physical restraint application, and arti cial vs. natural light exposure [24][25][26].…”

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confidence: 99%

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Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

Moghadam

Miller

Rahimi–Bashar

et al. 2020

Preprint

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Background: To address whether in intensive care unit (ICU) patients, which factors correlate with development of delirium (primary outcome), as well as more rapid delirium onset and recurrence (secondary outcomes).Methods: A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors.Results: Increased delirium risk as associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95% CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95% CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95% CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95% CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95% CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95% CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95% CI: 0.456-0.567, P<0.001). CHAID modelling indicated that AL exposure and age <65 years conveyed a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex were associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age>65 years (HR 2.198; %95 CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95% CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables.Conclusion: Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 83%

Section: Natural Vs Arti Cial Lightmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

Moghadam

Miller

Rahimi–Bashar

et al. 2020

Preprint

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show abstract

“…Based on a retrospective secondary analysis of a multicenter cohort of patients with acute respiratory distress syndrome, Vahedian-Azimi and colleagues report a higher delirium incidence in patients exposed only to artificial light during ICU stay, as compared to patients admitted to a room with windows, allowing exposure to natural light [2]. This association was observed both in crude analyses and after adjustment for common delirium risk factors.…”

Section: Letter To the Editormentioning

confidence: 99%