Intensive Care Unit Room Characteristics and Association with the Development of Delirium

Delirium is associated with worse outcomes in critically ill patients. Factors that could reduce delirium are patients' environment and maintaining circadian cycles, but whether certain room characteristics improve the incidence of delirium is unclear. Our objective was to investigate whether the presence of windows or doors in patients' rooms is associated with lower rates of delirium.

In this retrospective, cohort study, adult, medical patients admitted to the Intensive Care Unit (ICU) between 1 January 2024 and 1 July 2024 were identified. Clinical and room characteristics were collected. The primary outcome was the development of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) positive status. Secondary outcomes included ICU and hospital length of stay (LOS) and mortality.

Four hundred fifty-eight (458) patients met inclusion criteria (mean age 61.7 +/- 16.4 years; 51.3% male). In the adjusted multivariate analysis, neither the presence of windows (aOR 2.2; 95% CI 0.7-6.2; p = 0.155) nor closed-format rooms (aOR 0.1; 95% CI 0.0-1.2; p = 0.077) were significantly associated with CAM-ICU positivity. Although an initial association was observed between the presence of windows and increased hospital LOS (aMR 1.4; 95% CI 1.1-1.8; p = 0.008), this did not maintain statistical significance after False Discovery Rate (FDR) correction (q > 0.05). No significant associations were found for other secondary outcomes, including ICU mortality or ICU LOS.

Room characteristics were not significantly associated with delirium or secondary outcomes after FDR correction. However, given the study's limited power to detect moderate differences, these findings do not definitively rule out an architectural influence on delirium and warrant further investigation in larger cohorts. Studies with more discrete measurement of room characteristics are needed to investigate these associations further.