Oliver Karam, PhD, MD,
Professor, Division Chief
Virginia Commonwealth University Medical Center, United States
Disclosure information not submitted.
Kara Greenfield, DO
Children's Hospital of Richmond at VCU, VA
Disclosure information not submitted.
Alia Marie O'Meara, MD
Pediatric Critical Care Med
Childrens Hospital of Richmond at VCU
Portsmouth, VA
Disclosure information not submitted.
Title: Stuck in the Dark: No Association between Light, Sound, and Delirium in the PICU
Introduction/Hypothesis: Pediatric delirium is associated with increased morbidity and mortality. Despite the growing focus on pediatric delirium in the past decade, we still have no clear etiology or specific treatments to offer. Our primary objective was to evaluate the association between sound and light variables and development of delirium within the subsequent three days.
Methods: Light and sound measurements were continuously recorded in the rooms of critically ill patients through the first 14 PICU days or until discharge, whichever came first. Patient-specific data was collected for each day of admission, including mechanical ventilation, medications, and diagnosis of delirium by CAPD score.
Results: 142 patients were enrolled, for a total of 896 study days. The median age was 1.6yr (IQR 0.4-6.7), 39% were female, and 30% had developmental delay. Median PELOD-2 score was 2 (IQR 0-6). Seventy-nine patients (55%) were ‘ever-delirious’, with at least 1 study day with CAPD score > 9, with an overall prevalence of delirium on 31% of study days. Younger age, higher study day, and receipt of benzodiazepines, dexmedetomidine or clonidine were all associated with development of delirium in the next 3 days. Nighttime sound peaks ( >70 and >80dB) were not associated with the development of delirium (p=0.94 and 0.36, respectively). Light intensity during midday hours (12:00, 13:00, 14:00) was not associated with development of delirium (p=0.93, 0.81, 0.83, respectively), nor was maximum light at night, difference between maximum daytime and nighttime light, or between maximum and minimum daytime light (p=0.15, p=0.46 and 0.96, respectively). When adjusting for co-variables, none of the sound or light variables was independently associated with the development of delirium.
Conclusions: Our results suggest there is no association between light or sound and development of delirium in critically ill children. However, there was little difference between daytime and nighttime light and sound, which may have impacted these findings. Given that the etiology of delirium is likely multifactorial and potentially different for individual patients, targeted light/dark cycles warrant further study as they relate to pediatric delirium.