Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Alawi Luetz, MD, PhD; Julius J. Grunow; Rudolf Mörgeli, MD; Max Rosenthal, MD, PhD; Steffen Weber-Carstens, MD, PhD; Bjoern Weiss; Claudia Spies, MD, PhD


Semin Respir Crit Care Med. 2019;40(5):673-686. 

In This Article

Environment as a Treatment Tool

Looking more specifically at the ICU environment, it has been recognized that the high-technology setting, into which patients are placed during one of the most vulnerable moments of their lives, can be a potential stressor that negatively affects outcomes.[17–19]

Investigations on ICU-stressors consistently showed that sleeplessness and constant exposure to noise and lights are among the top stressors for patients in the ICU.[20–22] While certain stressful elements of the patient surroundings result from inevitable aspects of the treatment (e.g., diagnostic or therapeutic interventions), many other aspects might be specifically modified to positively affect the patient, without negatively impacting outcomes and staff work-flows.[23] It has long been hypothesized that environmental stressors, such as high-noise levels and inappropriate lighting conditions, even predispose patients to complications, such as delirium.[18,24] Innovative approaches for environmental modifications do not merely reduce stress but may enhance recovery as a specific therapeutic intervention. These modifications might be especially useful to prevent aspects of the PICS. PICS is a syndrome that encompasses deficits commonly observed in critically ill patients following their treatment in the ICU. The deficits can fall into one or more of the following subcategories of PICS: mental health, cognition, and mobility.[25]

PICS is associated with a reduced return to work rate and quality of life of patients, as well as mental health issues, for caregivers and family members.[26–28] The unique deficits of the PICS-spectrum suggest an expansion of the concept of critical illness beyond the ICU stay.[29]

The public health burden of ICU survivorship is a major contributor to the total health care costs of critically-ill patients.[30,31] As such, approaches to optimize long-term disease trajectories of ICU patients should also focus on decreasing the burden of PICS.

In the following sections, we will review and discuss different solutions aiming at the reduction of delirium and PICS, focusing on prevention and direct therapeutic use of environment-related innovations.