Non-circadian signals in the intensive care unit: Point prevalence morning, noon and night.

Single-site, before-and-after quality improvement study with no control ICU and no randomisation. It observed room lights, television, window shades, doors, curtains and mechanical ventilation status; it did not measure patient sleep, delirium, anxiety, pain or clinical outcomes. No identifying patient data were collected, and the only patient-related variable was mechanical ventilation status, so other patient factors such as time since ICU admission or patient preference could not be assessed. The Naptime protocol bundled several changes at once, including clustered care, rescheduling medications, labs, imaging, vital signs, invasive monitoring and skin or wound care, plus lights, television, shades, curtains and door actions; the study cannot tell which component drove any change. Post-intervention surveys were done only once, about one month after implementation, so lasting behavior change was not assessed. Some observed measures, such as degree of door curtain or window shade closure, were subjective, although investigators had perfect agreement during a pilot survey.

The authors declared no conflicts of interest or financial disclosures. The article is listed as supported by NIH extramural research.

Do not read the changes in lights, shades, curtains, doors and television as proof that ICU patients slept better or had less delirium. The study observed room environment only and did not measure patient sleep or clinical outcomes. Also, do not credit any single action, because the protocol bundled clustered care, rescheduling medications, labs, imaging, vital signs, invasive monitoring and skin or wound care, reducing in-room activity, noise and light, turning off lights and televisions, closing window shades, curtains and doors, and opening window shades and keeping room light during daytime.