Looking for light in the din: An examination of the circadian-disrupting properties of a medical intensive care unit
Looking for light in the din: An examination of the circadian-disrupting properties of a medical intensive care unit
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DOI：
10.1016/j.iccn.2017.12.006
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发表时间：
2018-06-01
影响因子：
5.3
通讯作者：
Gehlbach, Brian K.
中科院分区：
文献类型：
--
作者：
Danielson, Samantha J.;Rappaport, Charles A.;Gehlbach, Brian K.
目的：危重患者表现出严重的昼夜节律紊乱，最常见的形式是相延迟。我们研究了医疗重症监护病房的特定授时细胞特性，以建立一个解释这些异常的模型。研究方法：2013-2014年进行前瞻性观察性研究。在病房中测量24小时环境光（勒克斯，672小时）和声压级（dBA， 504小时）。调查了患者和家属对环境的看法。环境：以大学为基地的成人医疗加护病房。主要结果测量：环境光-暗周期和声音环境的时间和强度以及这些测量与患者/家属感知的关系。结果：24小时明暗周期相对太阳周期极弱且相位延迟。当只有24.9% +/- 10.9%的可用光被利用时，晨光平均为12.1（4.8,37.2）勒克斯；然而，患者和家属并不认为白天的低光照水平有问题。中位噪声水平总是过高（夜间47.9 [45.0,51.3]dBA），变化最小，与没有规定的休息时间一致。结论：重症监护病房是一个几乎恒定的常规协议，与太阳时间断开。促进娱乐的行为干预应以光和声音的客观测量为支持。(C) 2017 Elsevier Ltd.版权所有。
Objective: Critically ill patients exhibit profound disturbances of circadian rhythmicity, most commonly in the form of a phase delay. We investigated the specific zeitgeber properties of a medical intensive care unit to develop a model that explained these abnormalities.Research methodology: Prospective, observational study conducted during 2013-2014. Twenty-four-hour ambient light (lux, 672 hours) and sound pressure levels (dBA, 504 hours) were measured in patient rooms. Patients and families were surveyed regarding their perceptions of the environment.Setting: University-based adult medical intensive care unit.Main outcome measures: The timing and intensity of the ambient light-dark cycle and sound environment and the relationship of these measurements to patient/family perceptions.Results: Twenty-four-hour light-dark cycles were extremely weak and phase delayed relative to the solar cycle. Morning light averaged 12.1 (4.8, 37.2) lux, when only 24.9% +/- 10.9% of available light was utilised; yet patients and families did not identify low daytime light levels as problematic. Median noise levels were invariably excessive (nighttime 47.9 [45.0, 51.3] dBA) with minimal variation, consistent with the absence of a defined rest period.Conclusion: The intensive care unit functions as a near-constant routine protocol disconnected from solar time. Behavioural interventions to promote entrainment should be supported by objective measurements of light and sound. (C) 2017 Elsevier Ltd. All rights reserved.