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Brighter Days May Be Ahead: Continuous Measurement of Pediatric Intensive Care Unit Light and Sound
Kara D Greenfield1, Oliver Karam1, A M Iqbal O'Meara1
1Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States.
Insights
Critically ill children in pediatric intensive care units (PICUs) experience consistently low light levels and high sound levels, exceeding WHO recommendations. Further research is needed to explore the clinical effects of these environmental factors on patient outcomes.
Area of Science:
- Pediatric Intensive Care
- Environmental Health
- Critical Care Medicine
Background:
- The intensive care environment significantly impacts patient recovery.
- Light and sound are crucial environmental factors influencing sleep-wake cycles and physiological responses.
- Understanding the specific characteristics of light and sound in pediatric intensive care units (PICUs) is essential for optimizing patient care.
Purpose of the Study:
- To quantify and characterize light and sound levels within PICU rooms.
- To compare environmental conditions between newly constructed and older sections of a PICU.
- To establish baseline data for potential interventions aimed at improving the PICU environment for critically ill children.
Main Methods:
- A prospective observational cohort study was conducted in a tertiary care PICU.
- Continuous measurements of light (lux) and sound (decibels, dB) levels were recorded over 602 patient-days.
- Data were collected from 100 critically ill children aged 0-18 years requiring respiratory or cardiovascular support.
Main Results:
- Twenty-four hour median illuminance was 16 lux, with daytime levels at 27 lux and overnight levels at 4 lux.
- Daytime sound levels (LAeq) averaged 62 dB, significantly exceeding the World Health Organization's recommended <35 dB.
- Higher light levels were observed in new rooms during midday, but sound levels did not differ between new and older rooms.
Conclusions:
- PICU rooms exhibit low light levels and high sound levels, potentially impacting patient well-being.
- Observed sound levels consistently surpass established hospital guidelines.
- The clinical impact of these environmental factors on critically ill children warrants further investigation as potentially modifiable elements of care.
Abstract:
Objective: To describe light and sound characteristics in the rooms of critically ill children. Design: Prospective observational cohort study, with continuously measured light and sound levels. Setting: Tertiary care pediatric intensive care unit (PICU), with a newly constructed expansion and an older, pre-existing section. Patients: Critically ill patients 0-18 years old, requiring respiratory or cardiovascular support. Patients with severe cognitive pre-conditions were excluded. Measurements and Main Results: One hundred patients were enrolled, totaling 602 patient-days. The twenty-four hour median illuminance was 16 (IQR 5-53) lux (lx). Daytime (07:00-21:00) median light level was 27 lx (IQR 13-82), compared with 4 lx (IQR 1-10) overnight (22:00-06:00). Peak light levels occurred midday between 11:00 and 14:00, with a median of 48 lx (IQR 24-119). Daytime median illuminance trended higher over the course of admission, whereas light levels overnight were consistent. Midday light levels were higher in newly constructed rooms: 78 lx (IQR 30-143) vs. 26 lx (IQR 20-40) in existing rooms. The twenty-four hour median equivalent sound level (LAeq) was 60 (IQR 55-64) decibels (dB). Median daytime LAeq was 62 dB (IQR 58-65) and 56 dB (IQR 52-61) overnight. On average, 35% of patients experienced at least one sound peak >80 dB every hour from 22:00 to 06:00. Overnight peaks, but not median sound levels nor daytime peaks, decreased over the course of admission. There was no difference in sound between new and pre-existing rooms. Conclusions: This study describes continuously measured light and sound in PICU rooms. Light levels were low even during daytime hours, while sound levels were consistently higher than World Health Organization hospital room recommendations of <35 dB. Given the relevance of light and sound to sleep/wake patterns, and evidence of post-intensive care syndromes, the clinical effects of light and sound on critically ill children should be further explored as potentially modifiable environmental factors.
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