Prospective Randomized Controlled Pilot Study of High-Intensity Lightbox Phototherapy to Prevent ICU-Acquired Delirium Incidence.

Kermit S Zhang,Susanti R Ie,Edmundo Rubio,Shahzad Hussain,Anthony Loschner,Tomer Pelleg,Mahtab B Foroozesh,Venkateswara Kollipara,Frank Biscardi

doi:10.7759/cureus.14246

Abstract

BackgroundThis study aimed to evaluate the role of disturbed circadian rhythm in potentiating intensive care unit (ICU)-acquired delirium.Previous studies have demonstrated bright light therapy (BLT) as an effective modality to improve sleeping patterns and cognitive function in non-critically ill patients. However, its benefit in the ICU has not been clearly established. In this study, we aimed to evaluate the application of daily high-intensity phototherapy at the bedside to deter ICU delirium incidence and duration.MethodologyThis was a single center, prospective study conducted in ICUs at the Carilion Roanoke Memorial Hospital in Roanoke, VA. Adults patients admitted to the ICU from July 9, 2018 to March 20, 2020 were included in the study. The patients were subjected to 30-minute BLT session (10,000 lux) at the bedside starting at 0700 while in the ICU. Patients were randomized into either the control group (standard hospital lighting) or phototherapy group. Data were analyzed using Wilcoxon rank sum test for continuous variables, Pearson chi-square test for categorical variables, and logistic regression for multivariable analysis that examined significant risk factors for ICU delirium.ResultsDelirium incidence between BLT (18%) and control (17.5%) groups was non-significant. Total number of delirium-free, coma-free days, as determined by Confusion Assessment Method for the ICU, demonstrated no differences between groups with a median of 28 days (p = 0.516). In multivariable analysis, patients with a Sequential Organ Failure Assessment Score >3 also showed no significant change in ICU delirium incidence when provided bedside BLT compared to those with standard hospital lighting (odds ratio: 0.08; 95% confidence interval: 0.002-1.40; p = 0.867).ConclusionsIn this randomized control pilot study, daily morning 10,000 lux BLT of 30-minute duration alone was not associated with a significant decrease in ICU-acquired delirium incidence or duration compared to standard hospital lighting. Future studies should consider a nuanced approach to better elucidate the role of disturbed circadian rhythm in influencing ICU-acquired delirium by not only undertaking BLT during the day but also minimizing nighttime light exposure.

Highlights

Delirium is a non-specific but reversible acute change in baseline mentation that can arise from many causes that cannot be accounted for by a baseline neurocognitive disorder or a severely reduced level or arousal
Review began 03/18/2021 Review ended 03/24/2021 Published 04/01/2021. In this randomized control pilot study, daily morning 10,000 lux bright light therapy (BLT) of 30-minute duration alone was not associated with a significant decrease in intensive care unit (ICU)-acquired delirium incidence or duration compared to standard hospital lighting
Future studies should consider a nuanced approach to better elucidate the role of disturbed circadian rhythm in influencing ICU-acquired delirium by undertaking BLT during the day and minimizing nighttime light exposure

Summary

Introduction

Delirium is a non-specific but reversible acute change in baseline mentation that can arise from many causes that cannot be accounted for by a baseline neurocognitive disorder or a severely reduced level or arousal. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition defines delirium as one that encompasses a change in consciousness, cognition, and perception accompanied with an acute onset and transient fluctuation throughout the day. It is a serious condition that has been associated with poor clinical outcomes, including increased days on mechanical ventilation, length of hospital stay, long-term cognitive impairment, cost of care, and mortality. How to cite this article Zhang K S, Pelleg T, Hussain S, et al (April 01, 2021) Prospective Randomized Controlled Pilot Study of High-Intensity Lightbox Phototherapy to Prevent ICU-Acquired Delirium Incidence. This study aimed to evaluate the role of disturbed circadian rhythm in potentiating intensive care unit (ICU)-acquired delirium. We aimed to evaluate the application of daily high-intensity phototherapy at the bedside to deter ICU delirium incidence and duration

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