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.

Keywords

critical care - intensive care unit - architecture - post–intensive care unit syndrom - delirium - nonpharmacological - light - noise - sound - mobility - physiotherapy

• References

• 1 Wilson LM. Intensive care delirium. The effect of outside deprivation in a windowless unit. Arch Intern Med 1972; 130 (02) 225-226
• 2 Lawton MP, Liebowitz B, Charon H. Physical structure and the behavior of senile patients following ward remodeling. Aging Hum Dev 1970; 1 (03) 231-239
• 3 Ulrich RS, Zimring C, Zhu X. , et al. A review of the research literature on evidence-based healthcare design. HERD 2008; 1 (03) 61-125
• 4 Lassen HCA. A preliminary report on the 1952 epidemic of poliomyelitis in Copenhagen with special reference to the treatment of acute respiratory insufficiency. Lancet 1953; 1 (6749): 37-41
• 5 Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med 2012; 185 (05) 486-497
• 6 Petty TL. Suspended life or extending death?. Chest 1998; 114 (02) 360-361
• 7 Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342 (20) 1471-1477
• 8 Girard TD, Kress JP, Fuchs BD. , et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 2008; 371 (9607): 126-134
• 9 Ely EW, Baker AM, Dunagan DP. , et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335 (25) 1864-1869
• 10 Shehabi Y, Bellomo R, Reade MC. , et al; Sedation Practice in Intensive Care Evaluation (SPICE) Study Investigators; ANZICS Clinical Trials Group. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012; 186 (08) 724-731
• 11 Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375 (9713): 475-480
• 12 Baron R, Binder A, Biniek R. , et al; DAS-Taskforce 2015. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci 2015; 13: Doc19
• 13 Devlin JW, Skrobik Y, Gélinas C. , et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2018; 46 (09) e825-e873
• 14 Adams A. Decoding modern hospitals: an architectural history. Archit Des 2017; 87 (02) 16-23
• 15 Moss H, O'Neill D. Aesthetic deprivation in clinical settings. Lancet 2014; 383 (9922): 1032-1033
• 16 Anderson DC, Pang SA, O'Neill D, Edelstein EA. The convergence of architectural design and health. Lancet 2018; 392 (10163): 2432-2433
• 17 Zaal IJ, Spruyt CF, Peelen LM. , et al. Intensive care unit environment may affect the course of delirium. Intensive Care Med 2013; 39 (03) 481-488
• 18 Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 2012; 16 (03) R73
• 19 Wenham T, Pittard A. Contin Educ Anaesth Crit Care Pain 2009; 9 (06) 178-183
• 20 Abuatiq A. Patients' and health care providers' perception of stressors in the intensive care units. Dimens Crit Care Nurs 2015; 34 (04) 205-214
• 21 Pang PSK, Suen LKP. Stressors in the ICU: a comparison of patients' and nurses' perceptions. J Clin Nurs 2008; 17 (20) 2681-2689
• 22 Novaes MA, Aronovich A, Ferraz MB, Knobel E. Stressors in ICU: patients' evaluation. Intensive Care Med 1997; 23 (12) 1282-1285
• 23 Thompson DR, Hamilton DK, Cadenhead CD. , et al. Guidelines for intensive care unit design. Crit Care Med 2012; 40 (05) 1586-1600
• 24 Mistraletti G, Carloni E, Cigada M. , et al. Sleep and delirium in the intensive care unit. Minerva Anestesiol 2008; 74 (06) 329-333
• 25 Needham DM, Davidson J, Cohen H. , et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med 2012; 40 (02) 502-509
• 26 Harvey MA, Davidson J. Long-term consequences of critical illness: a new opportunity for high-impact critical care nurses. Crit Care Nurse 2011; 31 (05) 12-15
• 27 Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med 2011; 39 (02) 371-379
• 28 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med 2012; 40 (02) 618-624
• 29 Needham DM, Feldman DR, Kho ME. The functional costs of ICU survivorship. Collaborating to improve post-ICU disability. Am J Respir Crit Care Med 2011; 183 (08) 962-964
• 30 Cheung AM, Tansey CM, Tomlinson G. , et al. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 2006; 174 (05) 538-544
• 31 Unroe M, Kahn JM, Carson SS. , et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 2010; 153 (03) 167-175
• 32 Basner M, Babisch W, Davis A. , et al. Auditory and non-auditory effects of noise on health. Lancet 2014; 383 (9925): 1325-1332
• 33 Scholl B, Gao X, Wehr M. Nonoverlapping sets of synapses drive on responses and off responses in auditory cortex. Neuron 2010; 65 (03) 412-421
• 34 Kirste I, Nicola Z, Kronenberg G, Walker TL, Liu RC, Kempermann G. Is silence golden? Effects of auditory stimuli and their absence on adult hippocampal neurogenesis. Brain Struct Funct 2015; 220 (02) 1221-1228
• 35 Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci 2013; 17 (04) 179-193
• 36 Loomba RS, Arora R, Shah PH, Chandrasekar S, Molnar J. Effects of music on systolic blood pressure, diastolic blood pressure, and heart rate: a meta-analysis. Indian Heart J 2012; 64 (03) 309-313
• 37 Martin-Saavedra JS, Vergara-Mendez LD, Pradilla I, Vélez-van-Meerbeke A, Talero-Gutiérrez C. Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials. Complement Ther Med 2018; 41: 81-89
• 38 Drahota A, Ward D, Mackenzie H. , et al. Sensory environment on health-related outcomes of hospital patients. Cochrane Database Syst Rev 2012; (03) CD005315
• 39 Bernardi L, Porta C, Sleight P. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence. Heart 2006; 92 (04) 445-452
• 40 Delaney L, Litton E, Van Haren F. The effectiveness of noise interventions in the ICU. Curr Opin Anaesthesiol 2019; 32 (02) 144-149
• 41 Mateu-Capell M, Arnau A, Juvinyà D, Montesinos J, Fernandez R. Sound isolation and music on the comfort of mechanically ventilated critical patients. Nurs Crit Care 2018
• 42 Kahn DM, Cook TE, Carlisle CC, Nelson DL, Kramer NR, Millman RP. Identification and modification of environmental noise in an ICU setting. Chest 1998; 114 (02) 535-540
• 43 Medrzycka-Dabrowska W, Lewandowska K, Kwiecień-Jaguś K, Czyż-Szypenbajl K. Sleep deprivation in intensive care unit - systematic review. Open Med (Wars) 2018; 13: 384-393
• 44 Inouye SK, Bogardus Jr ST, Charpentier PA. , et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340 (09) 669-676
• 45 Litton E, Carnegie V, Elliott R, Webb SA. The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: a systematic review and meta-analysis. Crit Care Med 2016; 44 (05) 992-999
• 46 van de Pol I, van Iterson M, Maaskant J. Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis. Intensive Crit Care Nurs 2017; 41: 18-25
• 47 Terzi B, Azizoğlu F, Polat Ş, Kaya N, İşsever H. The effects of noise levels on nurses in intensive care units. Nurs Crit Care 2019
• 48 Crawford KJ, Barnes LA, Peters TM, Falk J, Gehlbach BK. Identifying determinants of noise in a medical intensive care unit. J Occup Environ Hyg 2018; 15 (12) 810-817
• 49 Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 2012; 16 (03) R73
• 50 Demoule A, Carreira S, Lavault S. , et al. Impact of earplugs and eye mask on sleep in critically ill patients: a prospective randomized study. Crit Care 2017; 21 (01) 284
• 51 Richardson A, Allsop M, Coghill E, Turnock C. Earplugs and eye masks: do they improve critical care patients' sleep?. Nurs Crit Care 2007; 12 (06) 278-286
• 52 Luetz A, Weiss B, Penzel T. , et al. Feasibility of noise reduction by a modification in ICU environment. Physiol Meas 2016; 37 (07) 1041-1055
• 53 Goeren D, John S, Meskill K, Iacono L, Wahl S, Scanlon K. Quiet time: a noise reduction initiative in a neurosurgical intensive care unit. Crit Care Nurse 2018; 38 (04) 38-44
• 54 Simons KS, Verweij E, Lemmens PMC. , et al. Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units. Crit Care 2018; 22 (01) 250
• 55 Lim R. Benefits of quiet time interventions in the intensive care unit: a literature review. Nurs Stand 2018; 32 (30) 41-48
• 56 Shen S, Roy N, Guan J, Hassanieh H, Choudhury RR. . MUTE: bringing IoT to noise cancellation. 2018 ; Doi:10.1145/3230543.3230550
• 57 Umbrello M, Sorrenti T, Mistraletti G, Formenti P, Chiumello D, Terzoni S. Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiol 2019; 85 (08) 886-898
• 58 Khan SH, Wang S, Harrawood A. , et al. Decreasing delirium through music (DDM) in critically ill, mechanically ventilated patients in the intensive care unit: study protocol for a pilot randomized controlled trial. Trials 2017; 18 (01) 574
• 59 Gallacher S, Enki D, Stevens S, Bennett MJ. An experimental model to measure the ability of headphones with active noise control to reduce patient's exposure to noise in an intensive care unit. Intensive Care Med Exp 2017; 5 (01) 47
• 60 Chlan LL, Heiderscheit A, Skaar DJ, Neidecker MV. Economic evaluation of a patient-directed music intervention for ICU patients receiving mechanical ventilatory support. Crit Care Med 2018; 46 (09) 1430-1435
• 61 Ishizaki Y, Ishizaki T, Fukuoka H. , et al. Changes in mood status and neurotic levels during a 20-day bed rest. Acta Astronaut 2002; 50 (07) 453-459
• 62 Bein T, Bischoff M, Brückner U. , et al. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist 2015; 64 (Suppl 1): 1-26
• 63 Schweickert WD, Pohlman MC, Pohlman AS. , et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373 (9678): 1874-1882
• 64 Schaller SJ, Anstey M, Blobner M. , et al; International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388 (10052): 1377-1388
• 65 Hodgson C, Bellomo R, Berney S. , et al; TEAM Study Investigators. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 2015; 19 (01) 81
• 66 Hewson-Conroy KM, Burrell AR, Elliott D. , et al. Compliance with processes of care in intensive care units in Australia and New Zealand--a point prevalence study. Anaesth Intensive Care 2011; 39 (05) 926-935
• 67 Dubb R, Nydahl P, Hermes C. , et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc 2016; 13 (05) 724-730
• 68 Puthucheary ZA, Rawal J, McPhail M. , et al. Acute skeletal muscle wasting in critical illness. JAMA 2013; 310 (15) 1591-1600
• 69 Wollersheim T, Woehlecke J, Krebs M. , et al. Dynamics of myosin degradation in intensive care unit-acquired weakness during severe critical illness. Intensive Care Med 2014; 40 (04) 528-538
• 70 Mortimer JT, Bhadra N. Fundamentals of electrical stimulation. In: Krames S, Peckham PH, Rezai AR, eds. Neuromodulation. Elsevier; 2009: 109-121
• 71 Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest 2003; 124 (01) 292-296
• 72 Nuhr MJ, Pette D, Berger R. , et al. Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure. Eur Heart J 2004; 25 (02) 136-143
• 73 Gibson JNA, Smith K, Rennie MJ. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet 1988; 2 (8614): 767-770
• 74 Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care 2014; 29 (06) 1082-1088
• 75 Wollersheim T, Grunow JJ, Carbon NM. , et al. Muscle wasting and function after muscle activation and early protocol-based physiotherapy: an explorative trial. J Cachexia Sarcopenia Muscle 2019; 10 (04) 734-747
• 76 Weber-Carstens S, Schneider J, Wollersheim T. , et al. Critical illness myopathy and GLUT4: significance of insulin and muscle contraction. Am J Respir Crit Care Med 2013; 187 (04) 387-396
• 77 Parry SM, Berney S, Warrillow S. , et al. Functional electrical stimulation with cycling in the critically ill: a pilot case-matched control study. J Crit Care 2014; 29 (04) 695.e1-695.e7
• 78 Wang HH, Chen WH, Liu C, Yang WW, Huang MY, Shiang TY. Whole-body vibration combined with extra-load training for enhancing the strength and speed of track and field athletes. J Strength Cond Res 2014; 28 (09) 2470-2477
• 79 Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A, Schoenau E. Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta. Clin Rehabil 2008; 22 (05) 387-394
• 80 Chang SF, Lin PC, Yang RS, Yang RJ. The preliminary effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life among older people with sarcopenia. BMC Geriatr 2018; 18 (01) 17
• 81 Zaidell LN, Mileva KN, Sumners DP, Bowtell JL. Experimental evidence of the tonic vibration reflex during whole-body vibration of the loaded and unloaded leg. PLoS One 2013; 8 (12) e85247
• 82 Eklund G, Hagbarth KE. Normal variability of tonic vibration reflexes in man. Exp Neurol 1966; 16 (01) 80-92
• 83 Ceccarelli G, Benedetti L, Galli D. , et al. Low-amplitude high frequency vibration down-regulates myostatin and atrogin-1 expression, two components of the atrophy pathway in muscle cells. J Tissue Eng Regen Med 2014; 8 (05) 396-406
• 84 Wollersheim T, Haas K, Wolf S. , et al. Whole-body vibration to prevent intensive care unit-acquired weakness: safety, feasibility, and metabolic response. Crit Care 2017; 21 (01) 9
• 85 Lavender SA, Sommerich CM, Patterson ES. , et al. Hospital patient room design: the issues facing 23 occupational groups who work in medical/surgical patient rooms. HERD 2015; 8 (04) 98-114
• 86 Poncette AS, Spies C, Mosch L. , et al. Clinical requirements of future patient monitoring in the intensive care unit: qualitative study. JMIR Med Inform 2019; 7 (02) e13064
• 87 Vincent JL, Creteur J. The hospital of tomorrow in 10 points. Crit Care 2017; 21 (01) 93
• 88 Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices (Auckl) 2016; 9: 455-466
• 89 Bach Baunsgaard C, Vig Nissen U, Katrin Brust A. , et al. Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics. Spinal Cord 2018; 56 (02) 106-116
• 90 Rapolienė J, Endzelytė E, Jasevičienė I, Savickas R. Stroke patients motivation influence on the effectiveness of occupational therapy. Rehabil Res Pract 2018; 2018: 9367942
• 91 Ravi DK, Kumar N, Singhi P. Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: an updated evidence-based systematic review. Physiotherapy 2017; 103 (03) 245-258
• 92 Turolla A, Dam M, Ventura L. , et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil 2013; 10: 85
• 93 Huygelier H, Schraepen B, van Ee R, Vanden Abeele V, Gillebert CR. Acceptance of immersive head-mounted virtual reality in older adults. Sci Rep 2019; 9 (01) 4519
• 94 Gerber SM, Jeitziner MM, Wyss P. , et al. Visuo-acoustic stimulation that helps you to relax: A virtual reality setup for patients in the intensive care unit. Sci Rep 2017; 7 (01) 13228
• 95 Bergmann J, Krewer C, Bauer P, Koenig A, Riener R, Müller F. Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. Eur J Phys Rehabil Med 2018; 54 (03) 397-407
• 96 Dale HH, Douglas SR, Colebrook DC. The irradiation of school-children. Lancet 1931; 217 (5612): 669-670
• 97 The treatment of disease by artificial light. Nature Int J Sci 1923; 112 (2824): 866-867
• 98 Even C, Schröder CM, Friedman S, Rouillon F. Efficacy of light therapy in nonseasonal depression: a systematic review. J Affect Disord 2008; 108 (1-2): 11-23
• 99 Glickman G, Byrne B, Pineda C, Hauck WW, Brainard GC. Light therapy for seasonal affective disorder with blue narrow-band light-emitting diodes (LEDs). Biol Psychiatry 2006; 59 (06) 502-507
• 100 Boivin DB, Duffy JF, Kronauer RE, Czeisler CA. Dose-response relationships for resetting of human circadian clock by light. Nature 1996; 379 (6565): 540-542
• 101 Cirelli C, Tononi G. Is sleep essential?. PLoS Biol 2008; 6 (08) e216
• 102 Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: a meta-analytic review. Neurosci Biobehav Rev 2017; 80: 586-604
• 103 Harrison Y, Horne JA. The impact of sleep deprivation on decision making: a review. J Exp Psychol Appl 2000; 6 (03) 236-249
• 104 Wright Jr KP, Drake AL, Frey DJ. , et al. Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain Behav Immun 2015; 47: 24-34
• 105 Figueroa-Ramos MI, Arroyo-Novoa CM, Lee KA, Padilla G, Puntillo KA. Sleep and delirium in ICU patients: a review of mechanisms and manifestations. Intensive Care Med 2009; 35 (05) 781-795
• 106 Telias I, Wilcox ME. Sleep and circadian rhythm in critical illness. Crit Care 2019; 23 (01) 82
• 107 Boyko Y, Jennum P, Toft P. Sleep quality and circadian rhythm disruption in the intensive care unit: a review. Nat Sci Sleep 2017; 9: 277-284
• 108 Boyko Y, Toft P, Ørding H, Lauridsen JT, Nikolic M, Jennum P. Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality. Sleep Breath 2019; 23 (01) 379-388
• 109 Friese RS. Sleep and recovery from critical illness and injury: a review of theory, current practice, and future directions. Crit Care Med 2008; 36 (03) 697-705
• 110 Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care 2013; 17 (02) R46
• 111 Elliott R, McKinley S, Cistulli P, Fien M. ICU patients' sleep in an australian ICU is poor: A study using polysomnography. Aust Crit Care 2011; 24 (01) 54
• 112 McKinley S, Elliott R, Elliott D, Fien M. Intensive care patients reports that their sleep is poor. Aust Crit Care 2012; 25 (02) 124
• 113 Hastings MH, Maywood ES, Brancaccio M. Generation of circadian rhythms in the suprachiasmatic nucleus. Nat Rev Neurosci 2018; 19 (08) 453-469
• 114 Nakagawa H, Sack RL, Lewy AJ. Sleep propensity free-runs with the temperature, melatonin and cortisol rhythms in a totally blind person. Sleep 1992; 15 (04) 330-336
• 115 Sack RL, Lewy AJ. Circadian rhythm sleep disorders: lessons from the blind. Sleep Med Rev 2001; 5 (03) 189-206
• 116 Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res 2007; 16 (04) 372-380
• 117 Rikkert MGMO, Rigaud A-SP. Melatonin in elderly patients with insomnia.–A systematic review. Zeitschrift für Gerontologie und Geriatrie 2001; 34 (06) 491-497
• 118 Brzezinski A, Vangel MG, Wurtman RJ. , et al. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev 2005; 9 (01) 41-50
• 119 Ibrahim MG, Bellomo R, Hart GK. , et al. A double-blind placebo-controlled randomised pilot study of nocturnal melatonin in tracheostomised patients. Crit Care Resusc 2006; 8 (03) 187-191
• 120 Bourne RS, Mills GH, Minelli C. Melatonin therapy to improve nocturnal sleep in critically ill patients: encouraging results from a small randomised controlled trial. Crit Care 2008; 12 (02) R52
• 121 Hatta K, Kishi Y, Wada K. , et al; DELIRIA-J Group. Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry 2014; 71 (04) 397-403
• 122 Shigeta H, Yasui A, Nimura Y. , et al. Postoperative delirium and melatonin levels in elderly patients. Am J Surg 2001; 182 (05) 449-454
• 123 Brainard GC, Hanifin JP, Greeson JM. , et al. Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. J Neurosci 2001; 21 (16) 6405-6412
• 124 Brennan R, Jan JE, Lyons CJ. Light, dark, and melatonin: emerging evidence for the importance of melatonin in ocular physiology. Eye (Lond) 2007; 21 (07) 901-908
• 125 Nightingale F. Notes on Hospitals. Sapienza University of Rome:: Cambridge University Press;; 2009
• 126 Alibhai FJ, Tsimakouridze EV, Chinnappareddy N. , et al. Short-term disruption of diurnal rhythms after murine myocardial infarction adversely affects long-term myocardial structure and function. Circ Res 2014; 114 (11) 1713-1722
• 127 Joarder AR, Price ADF. Impact of daylight illumination on reducing patient length of stay in hospital after coronary artery bypass graft surgery. Light Res Technol 2012; 45 (04) 435-449
• 128 Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med 1999; 159 (4 Pt 1): 1155-1162
• 129 Wunsch H, Gershengorn H, Mayer SA, Claassen J. The effect of window rooms on critically ill patients with subarachnoid hemorrhage admitted to intensive care. Crit Care 2011; 15 (02) R81
• 130 Castro RA, Angus DC, Hong SY. , et al. Light and the outcome of the critically ill: an observational cohort study. Crit Care 2012; 16 (04) R132
• 131 Luetz A, Piazena H, Weiss B, Finke A, Willemeit T, Spies C. Patient-centered lighting environments to improve health care in the intensive care unit. Clin Health Promot 2016; 6 (01) 5-12
• 132 Chong MS, Tan KT, Tay L, Wong YM, Ancoli-Israel S. Bright light therapy as part of a multicomponent management program improves sleep and functional outcomes in delirious older hospitalized adults. Clin Interv Aging 2013; 8: 565-572
• 133 Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y. The usefulness of bright light therapy for patients after oesophagectomy. Intensive Crit Care Nurs 2011; 27 (03) 158-166
• 134 Simons KS, Laheij RJF, van den Boogaard M. , et al. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial. Lancet Respir Med 2016; 4 (03) 194-202
• 135 Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Med 2019; 45 (01) 1-12
• 136 Shen Y, Yan J, Cai G. High bright light therapy may reduce delirium incidence in critically ill patients. Intensive Care Med 2019; 45 (05) 755-756
• 137 Weiss B, Spies C, Piazena H, Penzel T, Fietze I, Luetz A. Exposure to light and darkness and its influence on physiological measures of intensive care unit patients-a systematic literature review. Physiol Meas 2016; 37 (09) R73-R87
• 138 Lockley SW, Skene DJ, Thapan K. , et al. Extraocular light exposure does not suppress plasma melatonin in humans. J Clin Endocrinol Metab 1998; 83 (09) 3369-3372
• 139 Perras B, Meier M, Dodt C. Light and darkness fail to regulate melatonin release in critically ill humans. Intensive Care Med 2007; 33 (11) 1954-1958
• 140 Brainard GC, Hanifin JP, Rollag MD. , et al. Human melatonin regulation is not mediated by the three cone photopic visual system. J Clin Endocrinol Metab 2001; 86 (01) 433-436
• 141 Thapan K, Arendt J, Skene DJ. An action spectrum for melatonin suppression: evidence for a novel non-rod, non-cone photoreceptor system in humans. J Physiol 2001; 535 (Pt 1): 261-267
• 142 Proceedings of CIE 2010 “Lighting Quality and Energy Efficiency.” Available from: http://files.cie.co.at/928_CIE%20x2035-2010%20%28ToC%29.pdf . Accessed September 9, 2019
• 143 Münch M, Nowozin C, Regente J. , et al. Blue-enriched morning light as a countermeasure to light at the wrong time: effects on cognition, sleepiness, sleep, and circadian phase. Neuropsychobiology 2016; 74 (04) 207-218
• 144 Durrington HJ, Clark R, Greer R. , et al. ‘In a dark place, we find ourselves’: light intensity in critical care units. Intensive Care Med Exp 2017; 5 (01) 9
• 145 Ring C, Nayak USL, Isaacs B. The effect of visual deprivation and proprioceptive change on postural sway in healthy adults. J Am Geriatr Soc 1989; 37 (08) 745-749
• 146 Merabet LB, Maguire D, Warde A, Alterescu K, Stickgold R, Pascual-Leone A. Visual hallucinations during prolonged blindfolding in sighted subjects. J Neuroophthalmol 2004; 24 (02) 109-113
• 147 Flynn WR. Visual hallucinations in sensory deprivation. A review of the literature, a case report and a discussion of the mechanism. Psychiatr Q 1962; 36 (1–4): 55-65
• 148 Colombo R, Corona A, Praga F. , et al. A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol 2012; 78 (09) 1026-1033
• 149 Ibrahim MM, Patwardhan A, Gilbraith KB. , et al. Long-lasting antinociceptive effects of green light in acute and chronic pain in rats. Pain 2017; 158 (02) 347-360
• 150 Pilorz V, Tam SKE, Hughes S. , et al. Melanopsin Regulates Both Sleep-Promoting and Arousal-Promoting Responses to Light. PLoS Biol 2016; 14 (06) e1002482
• 151 Ulrich RS. View through a window may influence recovery from surgery. Science 1984; 224 (4647): 420-421
• 152 Luetz A, He J, Weiss B. , et al. Parameterized visual content for symptom control in critically ill patients. Crit Care Med 2013; 41 (Suppl. 12) A212-A213
• 153 ESICM LIVES. Intensive Care Med Exp 2018; 6 (Suppl. 02) 682 Available from https://doi.org/10.1186%2Fs40635-018-0201-6. Accessed September 9, 2019
• 154 Anguera JA, Boccanfuso J, Rintoul JL. , et al. Video game training enhances cognitive control in older adults. Nature 2013; 501 (7465): 97-101