Direct Sunlight and Ventilator Weaning Outcomes

Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

RATIONALE

Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.

OBJECTIVES

To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

PANEL DESIGN

A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.

METHODS

Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.

RESULTS

The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

CONCLUSIONS

This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.

Mapping the impact of ICU design on patients, families and the ICU team: A scoping review

PURPOSE

Scoping review to map outcomes and describe effects of intensive care unit (ICU) design features on patients, family, and healthcare professionals (HCPs).

MATERIALS AND METHODS

Iteratively developed search strategy executed across seven databases. We included studies (January 2007 to May 2020) exploring ICU design features using any study design. We grouped studies into 12 design features and categorized outcomes into four domains.

RESULTS

Of 18,577 citations screened, 44 studies met inclusion criteria. Newly built or renovated ICUs/ICU rooms were evaluated in 27 (61%) studies; 17 (39%) evaluated existing designs/features. Most commonly evaluated design features were lighting (24, 55%), single vs multi-occupancy rooms/pods (17, 39%), and family-centered design (13, 30%). We identified 63 distinct outcomes in four domains; HCP-related (20, 45%); patient-related (20, 45%); family-related (11, 25%); and environment-related (7, 16%). Eleven (25%) studies measured patient/family-reported outcomes. In studies evaluating single occupancy rooms, three reported increased family satisfaction, two reported decreased delirium burden, while six reported negative consequences on HCP wellbeing and working.

CONCLUSION

Studies evaluating ICU design measure disparate outcomes. Few studies included patient/ family-reported outcomes; fewer measured objective environment characteristics. Single room layouts may benefit patients and family but contribute to adverse HCP-related outcomes.

Patients' Self-Reported Recovery After an Environmental Intervention Aimed to Support Patient's Circadian Rhythm in Intensive Care

BACKGROUND

Patients in intensive care units (ICUs) are among the most vulnerable, and they require support to start their recovery. The design of the patient area in the ICU can play a prominent role in both the quality of care and patients' recovery. The lighting environment has the opportunity to restore and strengthen the natural human circadian rhythm and health.

AIM

To evaluate patients' self-reported recovery after being cared for in an ICU room rebuilt according to evidence-based design principles that promote recovery.

METHOD

An intervention was set up in a two-bed patient room including a cycled lighting system. Self-reported recovery was reported at 6 and 12 months after discharge. Data were analyzed using a 2(mechanically ventilated, nonmechanically ventilated) × 2(intervention room, ordinary room) analysis of covariance (ANCOVA) and 2(male, women) × 2(intervention room, ordinary room) ANCOVA.

RESULTS

Data from the different rooms showed no significant main effects for recovery after 6 months, p = .21; however, after 12 months, it become significant, p. < .05. This indicated that patient recovery was positively influenced for patients cared for in the intervention room (M = 8.88, SD = 4.07) compared to the ordinary room (M = 10.90, SD = 4.26). There were no interaction effects for gender or if the patients had been mechanically ventilated either at 6 or 12 months' postdischarge.

CONCLUSIONS

A cycled lighting system may improve patient self-reported recovery after ICU care; however, more research on the topic is needed.

Rethinking the intensive care environment: considering nature in nursing practice

AIMS AND OBJECTIVES

With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes.

BACKGROUND

The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients.

DESIGN

This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units.

METHODS

Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice.

CONCLUSION

There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses.

RELEVANCE TO CLINICAL PRACTICE

Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes.