Acute Crit Care.  2021 Nov;36(4):332-341. 10.4266/acc.2021.00556.

Association of natural light exposure and delirium according to the presence or absence of windows in the intensive care unit

• Lee HJ
• Bae E
• Lee HY
• Lee SM
• Lee J

• KMID: 2524316
• DOI: http://doi.org/10.4266/acc.2021.00556

Abstract

Background
Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.
Methods
This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.
Results
Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220–3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125–0.805).
Conclusions
Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.

Keyword

delirium; intensive care unit; light

Figure

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  Figure 1. Unadjusted time to first delirium event. IQR: interquartile range.

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  Figure 2. Cox-proportional hazard analysis. HR: hazard ratio; CI: confidence interval. aVariables associated in univariate analysis and tested in the multivariate model: age, alcohol abuse, hypoxic brain injury, medical history of steroid use, mechanical ventilation, duration of mechanical ventilator apply, self-extubation, vasoactive agents, duration of remifentanil administration, duration of midazolam administration, duration of propofol administration, and duration of dexmedetomidine administration.

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