Light affects heart rate's 24-h rhythmicity in intensive care unit patients: an observational study.
24-h rhythm
ICU
Light
Journal
Nursing in critical care
ISSN: 1478-5153
Titre abrégé: Nurs Crit Care
Pays: England
ID NLM: 9808649
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
15
12
2018
revised:
08
04
2019
accepted:
10
04
2019
pubmed:
16
5
2019
medline:
30
4
2020
entrez:
16
5
2019
Statut:
ppublish
Résumé
Intensive care unit (ICU) patients experience two affronts to normal 24-h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions. We investigated the impact of light variance within an ICU on 24-h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population. Patients were assigned to beds either in the 'light' or 'dark' side within a single ICU. An actigraph continuously recorded light intensity for a 24-72-h period. Measurements of HR, MAP and BT were recorded every 30 min. HR, MAP and BT did not follow 24-h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147). ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24-h rhythm of HR. Larger, well-controlled studies also investigating the effect of relevant light intensity are indicated. Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions.
Sections du résumé
BACKGROUND
Intensive care unit (ICU) patients experience two affronts to normal 24-h rhythms: largely internal events such as medication and external factors such as light, noise and nursing interventions.
AIMS AND OBJECTIVES
We investigated the impact of light variance within an ICU on 24-h rhythmicity of three key physiological parameters: heart rate (HR), mean arterial blood pressure (MAP) and body temperature (BT) in this patient population.
DESIGN
Patients were assigned to beds either in the 'light' or 'dark' side within a single ICU. An actigraph continuously recorded light intensity for a 24-72-h period.
METHODS
Measurements of HR, MAP and BT were recorded every 30 min.
RESULTS
HR, MAP and BT did not follow 24-h rhythmicity in all patients. Higher light exposure in the Light Side of the ICU (122·3 versus 50·6 lx) was related to higher HR (89·4 versus 79·8 bpm), which may translate to clinically relevant outcomes in a larger sample. Duration of stay, the one clinical outcome measured in this study, showed no significant variation between the groups (p = 0·147).
CONCLUSIONS
ICU patients are exposed to varying light intensities depending on bed positioning relative to natural sunlight, affecting the 24-h rhythm of HR. Larger, well-controlled studies also investigating the effect of relevant light intensity are indicated.
RELEVANCE TO CLINICAL PRACTICE
Light is a variable that can be manipulated in the constrained environment of an ICU, thus offering an avenue for relatively unobtrusive interventions.
Types de publication
Journal Article
Observational Study
Langues
eng
Pagination
320-325Informations de copyright
© 2019 British Association of Critical Care Nurses.
Références
Bourcier S, Pichereau C, Boelle PY, Nemlaghi S, Dubée V, Lejour G, Baudel JL, Galbois A, Lavillegrand JR, Bigé N, Tahiri J, Leblanc G, Maury E, Guidet B, Ait-Oufella H. (2016). Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections. Annals of Intensive Care; 6: 63.
Brainard J, Gobel M, Scott B, Koeppen M, Eckle T. (2015). Health implications of disrupted circadian rhythms and the potential for daylight as therapy. Anesthesiology; 122: 1170-1175.
Castro RA, Angus DC, Hong SY, Lee C, Weissfeld LA, Clermont G, Rosengart MR. (2012). Light and the outcome of the critically ill: an observational cohort study. Critical Care; 16: R132.
Dianat I, Sedghi A, Bagherzade J, Jafarabadi MA, Stedmon AW. (2013). Objective and subjective assessments of lighting in a hospital setting: implications for health, safety and performance. Ergonomics; 56: 1535-1545.
Durrington HJ, Clark R, Greer R, Martial FP, Blaikley J, Dark P, Lucas RJ, Ray DW. (2017). “In a dark place, we find ourselves”: light intensity in critical care units. Intensive Care Medicine Experimental; 5: 9.
Elliott R, Rai T, McKinley S. (2014). Factors affecting sleep in the critically ill: an observational study. Journal of Critical Care; 29: 859-863.
Engwall M, Fridh I, Jutengren G, Bergbom I, Sterner A, Lindahl B. (2017). The effect of cycled lighting in the intensive care unit on sleep, activity and physiological parameters: a pilot study. Intensive & Critical Care Nursing; 41: 26-32.
Fan EP, Abbott SM, Reid KJ, Zee PC, Maas MB. (2017). Abnormal environmental light exposure in the intensive care environment. Journal of Critical Care; 40: 11-14.
Fonken LK, Nelson RJ. (2014). The effects of light at night on circadian clocks and metabolism. Endocrine Reviews; 35: 648-670.
Gaston KJ, Visser ME, Hölker F. (2015). The biological impacts of artificial light at night: the research challenge. Philosophical transactions of the Royal Society of London. Series B; 370: 20140133.
Hu R, Hegadoren KM, Wang X, Jiang X. (2016). An investigation of light and sound levels on intensive care units in China. Australian Critical Care; 29: 62-67.
Korompeli A, Muurlink O, Kavrochorianou N, Katsoulas T, Fildissis G, Baltopoulos G. (2017). Circadian disruption of ICU patients: a review of pathways, expression, and interventions. Journal of Critical Care; 38: 269-277.
Litscher D, Wang L, Gaischek I, Litscher G. (2013). The influence of new colored light stimulation methods on heart rate variability, temperature, and well-being: results of a pilot study in humans. Evidence-based Complementary and Alternative Medicine; 2013: 1-7.
McKenna HT, Reiss IK, Martin DS. (2017). The significance of circadian rhythms and dysrhythmias in critical illness. Journal of the Intensive Care Society; 18: 121-129.
McKenna H, van der Horst GTJ, Reiss I, Martin D. (2018). Clinical chronobiology: a timely consideration in critical care medicine. Critical Care; 22: 124.
Madrid-Navarro CJ, Sanchez-Galvez R, Martinez-Nicolas A, Marina R, Garcia JA, Madrid JA, Rol MA. (2015). Disruption of circadian rhythms and delirium, sleep impairment and sepsis in critically ill patients. Potential therapeutic implications for increased light-dark contrast and melatonin therapy in an ICU environment. Current Pharmaceutical Design; 21: 3453-3468.
Mistraletti G, Taverna M, Sabbatini G, Carloni E, Bolgiaghi L, Pirrone M, Cigada M, Destrebecq ALL, Carli F, Iapichino G. (2009). Actigraphic monitoring in critically ill patients: preliminary results toward an “observation-guided sedation”. Journal of Critical Care; 24: 563-567.
Motohashi Y, Reinberg A, Levi F, Nougier J, Benoit O, Foret J, Bourdeleau P. (1987). Axillary temperature: a circadian marker rhythm for shift workers. Ergonomics; 30: 1235-1247.
Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y. (2011). The usefulness of bright light therapy for patients after oesophagectomy. Intensive & Critical Care Nursing; 27: 158-166.
Paul T, Lemmer B. (2007). Disturbance of circadian rhythms in analgosedated intensive care unit patients with and without craniocerebral injury. Chronobiology International; 24: 45-61.
Portaluppi F, Smolensky MH, Touitou Y. (2010). Ethics and methods for biological rhythm research on animal and human beings. Chronobiology International; 27: 1911-1929.
Refinetti R, Lissen GC, Halberg F. (2007). Procedures for numerical analysis of circadian rhythms. Biological Rhythm Research; 38: 275-325.
Ritchie HK, Stothard ER, Wright KP. (2015). Entrainment of the human circadian clock to the light-dark cycle and its impact on patients in the ICU and nursing home settings. Current Pharmaceutical Design; 21: 3438-3442.
Simons KS, Laheij RJF, van den Boogaard M, Moviat MAM, Paling AJ, Polderman FN, Rozendaal FW, Salet GAM, van der Hoeven JG, Pickkers P, de Jager CPC. (2016). Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial. The Lancet Respiratory Medicine; 4: 194-202.
Stern M, Broja M, Sansone R, Gröne M, Skene SS, Liebmann J, Suschek CV, Born M, Kelm M, Heiss C. (2018). Blue light exposure decreases systolic blood pressure, arterial stiffness, and improves endothelial function in humans. European Journal of Preventive Cardiology; 25: 1875-1883.
Sunderram J, Sofou S, Kamisoglu K, Karantza V, Androulakis IP. (2014). Time-restricted feeding and the realignment of biological rhythms: translational opportunities and challenges. Journal of Translational Medicine; 12: 79.
Taguchi T. (2013). Bright light treatment for prevention of perioperative delirium in elderly patients. Journal of Nursing Education and Practice; 3: 10.
Taguchi T, Yano M, Kido Y. (2007). Influence of bright light therapy on postoperative patients: a pilot study. Intensive & Critical Care Nursing; 23: 289-297.
Touitou Y, Reinberg A, Touitou D. (2017). Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: health impacts and mechanisms of circadian disruption. Life Sciences; 173: 94-106.
Van Dycke KCG, Pennings JLA, van Oostrom CTM, van Kerkhof LWM, van Steeg H, van der Horst GTJ, Rodenburg W. (2015). Biomarkers for circadian rhythm disruption independent of time of day. PLoS One; 10: e0127075.
Vinzio S, Ruellan A, Perrin AE, Schlienger JL, Goichot B. (2003). Actigraphic assessment of the circadian rest-activity rhythm in elderly patients hospitalized in an acute care unit. Psychiatry and Clinical Neurosciences; 57: 53-58.
Weiss B, Spies C, Piazena H, Penzel T, Fietze I, Luetz A. (2016). Exposure to light and darkness and its influence on physiological measures of intensive care unit patients-a systematic literature review. Physiological Measurement; 37: R73-R87.