title: Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial.
abstract: BACKGROUND
  Disturbed circadian rhythm is a potentially modifiable cause of delirium among patients in intensive-care units (ICUs). Bright-light therapy in the daytime can realign circadian rhythm and reduce the incidence of delirium. We investigated whether a high-intensity dynamic light application (DLA) would reduce ICU-acquired delirium.
  
  
  METHODS
  This was a randomised, controlled, single-centre trial of medical and surgical patients admitted to the ICU of a teaching hospital in the Netherlands. Patients older than 18 years, expected to stay in the ICU longer than 24 h and who could be assessed for delirium were randomised to DLA or normal lighting (control), according to a computer-generated schedule. The DLA was administered through ceiling-mounted fluorescent tubes that delivered bluish-white light up to 1700 lux between 0900 h and 1600 h, except for 1130-1330 h, when the light was dimmed to 300 lux. The light could only be turned off centrally by investigators. Control light levels were 300 lux and lights could be turned on and off from inside the room. The primary endpoint was the cumulative incidence of ICU-acquired delirium. Analyses were by intention to treat and per protocol. The study was terminated prematurely after an interim analysis for futility. This study is registered with Clinicaltrials.gov, number NCT01274819.
  
  
  RESULTS
  Between July 1, 2011, and Sept 9, 2013, 734 patients were enrolled, 361 in the DLA group and 373 in the control group. Delirium occurred in 137 (38%) of 361 DLA patients and 123 (33%) of 373 control patients (odds ratio 1·24, 95% CI 0·92-1·68, p=0·16). No adverse events were noted in patients or staff.
  
  
  CONCLUSIONS
  DLA as a single intervention does not reduce the cumulative incidence of delirium. Bright-light therapy should be assessed as part of a multicomponent strategy.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands; Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands. Electronic address: k.simons@jbz.nl.
authors.forename: Koen S
authors.initials: KS
authors.lastname: Simons
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Robert J F
authors.initials: RJ
authors.lastname: Laheij
authors.affiliation: Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van den Boogaard
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Miriam A M
authors.initials: MA
authors.lastname: Moviat
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Paling
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Florens N
authors.initials: FN
authors.lastname: Polderman
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Frans W
authors.initials: FW
authors.lastname: Rozendaal
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Geertruda A M
authors.initials: GA
authors.lastname: Salet
authors.affiliation: Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Johannes G
authors.initials: JG
authors.lastname: van der Hoeven
authors.affiliation: Department of Intensive Care Medicine, Radboud University, Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.affiliation: Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.
authors.forename: Cornelis P C
authors.initials: CP
authors.lastname: de Jager
mesh_terms: D000368:Aged; D021081:Chronobiology Disorders / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D003422:Critical Care; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D057239:Early Termination of Clinical Trials; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D010789:Phototherapy / Q000379:methods*; D017211:Treatment Failure