title: Intensive care unit environment may affect the course of delirium.
abstract: OBJECTIVE
  Delirium is a common disorder in intensive care unit (ICU) patients. It is unclear whether ICU environment affects delirium. We investigated the influence of ICU environment on the number of days with delirium during ICU admission.
  
  
  METHODS
  In this prospective before-after study, ICU delirium was compared between a conventional ICU with wards and a single-room ICU with, among others, improved daylight exposure. We included patients admitted for more than 24 h between March and June 2009 (ICU with wards) or between June and September 2010 (single-room ICU). Patients who remained unresponsive throughout ICU admission were excluded. The presence of delirium in the preceding 24 h was assessed daily with the confusion assessment method for the ICU (CAM-ICU) by research physicians combined with evaluation of medical and nursing charts. The number of days with delirium was investigated with Poisson regression analysis.
  
  
  RESULTS
  We included 55 patients (449 observation days) in the ICU with wards and 75 patients (468 observation days) in the single-room ICU. After adjusting for confounding, the number of days with delirium decreased by 0.4 days (95 % confidence interval 0.1-0.7) in the single-room ICU (p = 0.005). The incidence of delirium during ICU stay was similar in the ICU with wards (51 %) and in the single-room ICU (45 %, p = 0.53).
  
  
  CONCLUSIONS
  This study is the first to show that ICU environment may influence the course of delirium in ICU patients.
authors.affiliation: Department of Intensive Care Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. i.j.zaal-2@umcutrecht.nl
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Zaal
authors.forename: Carolina F
authors.initials: CF
authors.lastname: Spruyt
authors.forename: Linda M
authors.initials: LM
authors.lastname: Peelen
authors.forename: Maarten M J
authors.initials: MM
authors.lastname: van Eijk
authors.forename: Rens
authors.initials: R
authors.lastname: Wientjes
authors.forename: Margriet M E
authors.initials: MM
authors.lastname: Schneider
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: Arjen J C
authors.initials: AJ
authors.lastname: Slooter
mesh_terms: D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006272:Health Facility Environment; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies