Application of a multisensory environment in the ICU: Effect on delirium and circadian rhythm regulation

To evaluate the impact of a multisensory environmental intervention designed to simulate and synchronize physiological circadian rhythms on the incidence of delirium and other clinical outcomes in critically ill patients admitted to an intensive care unit (ICU).

Pre-post quasi-experimental study without randomization, conducted between September 2023 and June 2024.

Adult Intensive Care Unit in a tertiary university hospital.

538 consecutive patients were included: 251 during the control period and 287 after implementation of the intervention.

Installation of the SHX® environmental stimulation system, which provides programmed transitions of light, image, and sound simulating sunrise and sunset, aimed at supporting circadian synchronization.

Incidence of delirium (assessed using the CAM-ICU tool), levels of sedation-agitation (RASS scale), and daily consumption of sedative drugs per day of ICU stay.

A non-significant reduction in the incidence of delirium was observed (14.3% vs. 9.1%; P = .075), along with a significant redistribution in sedation-agitation levels (P < .001) and a significant decrease in daily midazolam consumption per day of stay (9.6 mg vs. 3.8 mg; P = .019).

The implementation of a multisensory environment synchronized with the circadian rhythm was associated with improvements in delirium-related outcomes, sedation-agitation profiles, and benzodiazepine use. These findings support the use of non-pharmacological environmental interventions as complementary tools in the prevention of ICU delirium.