Proceedings of Réanimation 2018, the French Intensive Care Society International Congress

Abstract

Introduction: Delirium is frequent in intensive care unit (ICU) patients and is associated with increased mortality, increased hospital stay, increased cost and long term cognitive impairment in survivors. Numerous pharmacological and non‐pharmacological strategies have been investigated for delirium treatment without success. Therefore delirium prevention strategies are recommended by current critical care practice guidelines. Among the potentially modifiable risk factors for delirium, the impact of daylight exposure on delirium incidence and or duration has not been studied. The objective of this study was to investigate whether daylight exposition would reduce delirium burden in critically ill patients. Patients and methods: We conducted a prospective study in a 27‐bed medical intensive care unit (ICU) over a 1‐year period (January 2016‐January 2017). All consecutive adult patients receiving invasive mechanical ventilation (MV) for 2 days or more were eligible for the study. Patients were assigned to a room with windows allowing daylight exposure (“Light” group) or without window (“Dark” group), depending on bed availability. Delirium was evaluated with the Intensive Care Delirium Screening Checklist (ICDSC) for a maximum period of 28 days. Delirium was defined by a ICDSC score ≥ 4 for two consecutive days. Agitation was defined by a RASS > or = +2. The primary endpoint was cumulative incidence of delirium. Data are presented as median (interquartile range) or number (percentage). Results: A total of 195 patients were included (age‐50 [50 + 69] years, SAPS2‐51 [36 + 64], SOFA score‐9 [7 + 11], medical admission‐69%). Of them, 110 patients were admitted to a “Light” group and 85 to a “Dark” group. Incidence of known risk factors for delirium was similar in the two groups. Delirium occurred in 65 (64%) patients in the “Light” group and in 55 (71%) patients in the “Dark” group (p = 0.28). The duration of delirium was 3 [1 + 7] days. Patients in the “Light” group received significantly less neuroleptics to treat agitation than patients in the “Dark” group (13 vs. 25%, p = 0.04). This protective association persisted after adjustment for confounders in multivariate analysis (Odds ratio = 0.40 + [0.17 + 0.90] + p = 0.03). Conclusion: Daylight exposure does not impact on delirium burden in ICU mechanically ventilated patients. However, daylight exposure is independently associated with a reduced prescription of neuroleptics to treat agitation.