Clinical Chronobiology: A Timely Consideration in Critical Care Medicine

Helen McKenna; Gijsbertus T. J. van der Horst; Irwin Reiss; Daniel Martin


Crit Care. 2018;22(124) 

In This Article


Circadian rhythms are currently low on the list of physiological priorities during ICU ward rounds. We have argued that recognition of the influence of this universally important system, and adoption of chronobiological strategies, has the potential to improve patient outcomes.[38] Circadian rhythmicity represents one of the oldest survival strategies, present in all life-forms on earth. Traditional treatment of critical illness ignores this fundamental physiological function, with many of our interventions inadvertently obliterating it. A new chronobiological approach to patient care would involve: education for clinical staff, regarding the recognition of circadian rhythms and dysrhythmias; development of technology to measure circadian rhythms quantitatively in critically ill patients; and investing in multicomponent strategies (chronobundles) to preserve or restore the synchronicity, phase and amplitude of circadian rhythms. For the latter, pharmacological solutions remain untested, but the non-pharmacological components of these bundles are simple and logical interventions of relatively low cost. Any chronotherapy will ultimately need to take account of time of day and individual patient chronotype.