Acute and Critical Care

Original Articles

Neurology
Association of natural light exposure and delirium according to the presence or absence of windows in the intensive care unit: Hyo Jin Lee, Eunhye Bae, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee; Acute Crit Care. 2021;36(4):332-341. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00556

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Background
Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.
Methods
This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.
Results
Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220–3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125–0.805).
Conclusions
Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.

Citations

Citations to this article as recorded by

Innovate and renovate: Environmental intensive care unit design
Minnette Markus‐Rodden, Kristen Bell, Maryann Brookes, Georgia Harrison, Jeffrey O'Neill
Nursing in Critical Care.2025; 30(1): 75. CrossRef
Windows in the ICU and Postoperative Delirium: A Retrospective Cohort Study
Diana C. Anderson, Paige E. Warner, Matthew R. Smith, Marissa L. Albanese, Ariel L. Mueller, John Messervy, B. Christian Renne, Samuel J. Smith
Critical Care Medicine.2025; 53(3): e590. CrossRef
Daylighting and Patients’ Access to View Assessment in the Palestinian Hospitals’ ICUs
Deema Amleh, Abdelrahman Halawani, Muhannad Haj Hussein, Laith Alamlih
HERD: Health Environments Research & Design Journal.2025;[Epub] CrossRef
Light levels in a modern intensive care unit: Impact of time of year, window directionality, and outdoor light levels
Nikhil Chilakapati, Liz Timple, Sophia Pizzi, Janelle M. Fine, Hirsh Makhija, Lauryn K. Bruce, Robert L. Owens, Douglas Alden, Atul Malhotra, Jennifer L. Martin, Biren B. Kamdar
Chronobiology International.2025; 42(3): 351. CrossRef
Geriatric Psychiatric Emergencies
Michelle A. Fischer, Monica Corsetti
Emergency Medicine Clinics of North America.2024; 42(1): 135. CrossRef
There’s No Place Like Home: Delirium as a Barrier in Geriatric Trauma
Abdoulaziz Toure, Roshan Tadi, Mitchell Meagher, Catherine Ting Brown, Hoi Lam, Samantha LaRosa, Launick Saint-Fort, Huda Syed, Nathaniel Harshaw, Katherine Moore, Neelofer Sohail, Lindsey L. Perea
Journal of Surgical Research.2024; 293: 89. CrossRef
The Influence of Exposure to Nature on Inpatient Hospital Stays: A Scoping Review
Keegan Guidolin, Flora Jung, Sarah Hunter, Han Yan, Marina Englesakis, Stephen Verderber, Sami Chadi, Fayez Quereshy
HERD: Health Environments Research & Design Journal.2024; 17(2): 360. CrossRef
ICU design analysis: Are we really moving forward?
M Harazim
Anesteziologie a intenzivní medicína.2024; 35(1): 8. CrossRef
Restorative effects of daylight in indoor environments – A systematic literature review
Özge Karaman Madan, Kynthia Chamilothori, Juliëtte van Duijnhoven, Mariëlle P.J. Aarts, Yvonne A.W. de Kort
Journal of Environmental Psychology.2024; 97: 102323. CrossRef
Postoperative Delirium and Neurocognitive Disorders: A Comprehensive Review of Pathophysiology, Risk Factors, and Management Strategies
Sharayu Paunikar, Vivek Chakole
Cureus.2024;[Epub] CrossRef
Physical space of thirty pediatric intensive care units in the United States of America: a national survey
Oliver Karam, Aziez Ahmed, Matthew Bizzarro, Clifford Bogue, John S. Giuliano
Frontiers in Pediatrics.2024;[Epub] CrossRef
Exploratory analysis of factors influencing hospital preferences among the Lebanese population: a cross-sectional study
Christian-Joseph El Zouki, Abdallah Chahine, Elie Ghadban, Frederic Harb, Jamale El-Eid, Diala El Khoury
BMJ Open.2024; 14(11): e085727. CrossRef
Reinforcement learning model for optimizing dexmedetomidine dosing to prevent delirium in critically ill patients
Hong Yeul Lee, Soomin Chung, Dongwoo Hyeon, Hyun-Lim Yang, Hyung-Chul Lee, Ho Geol Ryu, Hyeonhoon Lee
npj Digital Medicine.2024;[Epub] CrossRef
Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future
Neil A. Halpern, Elizabeth Scruth, Michelle Rausen, Diana Anderson
Critical Care Clinics.2023; 39(3): 577. CrossRef
Improving healthcare value: integrating medical practitioners into hospital design in developing countries
Carlos Machhour Noujeim
Healthcare in Low-resource Settings.2023;[Epub] CrossRef
Evaluation of the sensory environment in a large tertiary ICU
Oystein Tronstad, Dylan Flaws, Sue Patterson, Robert Holdsworth, Veronica Garcia-Hansen, Francisca Rodriguez Leonard, Ruth Ong, Stephanie Yerkovich, John F. Fraser
Critical Care.2023;[Epub] CrossRef
2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
Acute and Critical Care.2022; 37(1): 1. CrossRef
Post-acute Delirium of COVID-19 Infection
Dai-Chun Chi, Chih-Pang Chu, Tien Wei Yang, Hu-Ming Chang
Taiwanese Journal of Psychiatry.2022; 36(1): 44. CrossRef
The future of intensive care: delirium should no longer be an issue
Katarzyna Kotfis, Irene van Diem-Zaal, Shawniqua Williams Roberson, Marek Sietnicki, Mark van den Boogaard, Yahya Shehabi, E. Wesley Ely
Critical Care.2022;[Epub] CrossRef
The effects of hypomagnesemia on delirium in middle-aged and older adult patients admitted to medical intensive care units
Joong-Yub Kim, Hyo Jin Lee, Hong Yeul Lee, Sang-Min Lee, Jinwoo Lee, Tae Yun Park
Acute and Critical Care.2022; 37(3): 407. CrossRef

Surgery
Feasibility of Percutaneous Dilatational Tracheostomy with a Light Source in the Surgical Intensive Care Unit: Jong-Kwan Baek, Jung-Sun Lee, Minchang Kang, Nak-Jun Choi, Suk-Kyung Hong; Acute Crit Care. 2018;33(2):89-94. Published online April 26, 2018; DOI: https://doi.org/10.4266/acc.2017.00563

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124 Download
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Abstract PDF

Background
Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU.
Methods
The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured.
Results
Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively.
Conclusions
PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy.

Citations

Citations to this article as recorded by

Increasing the precision of simulated percutaneous dilatational tracheostomy—a pilot prototype device development study
Athia Haron, Lutong Li, Eryl A. Davies, Peter D.G. Alexander, Brendan A. McGrath, Glen Cooper, Andrew Weightman
iScience.2024; 27(3): 109098. CrossRef
The feasibility and safety of percutaneous dilatational tracheostomy without endotracheal guidance in the intensive care unit
Ji Eun Kim, Dong Hyun Lee
Acute and Critical Care.2022; 37(1): 101. CrossRef
Safety and feasibility of hybrid tracheostomy
Daeun Kang, In Beom Jeong, Sun Jung Kwon, Ji Woong Son, Gwan Woo Ku
Acute and Critical Care.2021; 36(4): 369. CrossRef

Review Article

Surgery
Management of Critical Burn Injuries: Recent Developments: David J. Dries, John J. Marini; Korean J Crit Care Med. 2017;32(1):9-21. Published online February 17, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00969

27,733 View
1,593 Download
8 Web of Science
5 Crossref

Abstract PDF

Background
Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries.
Methods
A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association.
Results
The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems.
Conclusion
Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

Citations

Citations to this article as recorded by

Prevalence and Trend of Depression in Burn Survivors: A Single Center Cohort Study
V S Ranganath, Smitha Segu, B S Girish, Joel M Johns, C S Meghana
Journal of Burn Care & Research.2024; 45(4): 958. CrossRef
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Игорь Борисович Заболотских, Е. В. Григорьев, В. С. Афончиков, А. Ю. Буланов, С. В. Григорьев, А. Н. Кузовлев, В. В. Кузьков, Р. Е. Лахин, К. М. Лебединский, О. В. Орлова, Е. В. Ройтман, С. В. Синьков, Н. П. Шень, А. В. Щеголев
Annals of Critical Care.2024; (4): 7. CrossRef
SUBMICROSCOPIC CHANGES IN THE HEMOCAPILLARIES OF THE CEREBRAL HEMISCLE CAUSES CAUSED BY THERMAL BURN
H. V. Lukyantseva, V. A. Pastukhova, O. I. Kovalchuk
Bulletin of Problems Biology and Medicine.2021; 3(1): 268. CrossRef
Kefir Accelerates Burn Wound Healing Through Inducing Fibroblast Cell Migration In Vitro and Modulating the Expression of IL-1ß, TGF-ß1, and bFGF Genes In Vivo
Ahmad Oryan, Esmat Alemzadeh, Mohammad Hadi Eskandari
Probiotics and Antimicrobial Proteins.2019; 11(3): 874. CrossRef
Viable placental allograft as a biological dressing in the clinical management of full-thickness thermal occupational burns
Eric L. Johnson, Elisabet K. Tassis, Georgina M. Michael, Susan G. Whittinghill
Medicine.2017; 96(49): e9045. CrossRef

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