Light and the outcome of the critically ill: an observational cohort study

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• 作者：Ricardo A Castro (1) (2)
  Derek C Angus (1)
  Seo Yeon Hong (1)
  Chingwen Lee (1)
  Lisa A Weissfeld (1)
  Gilles Clermont (1)
  Matthew R Rosengart (1) (3)
  
• 刊名：Critical Care
• 出版年：2012
• 出版时间：August 2012
• 年：2012
• 卷：16
• 期：4
• 全文大小：
• 作者单位：Ricardo A Castro (1) (2)
  Derek C Angus (1)
  Seo Yeon Hong (1)
  Chingwen Lee (1)
  Lisa A Weissfeld (1)
  Gilles Clermont (1)
  Matthew R Rosengart (1) (3)
  
  1. The CRISMA Center (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
  2. Escuela de Medicina, Departamento de Medicina Intensiva, Pontificia Universidad Catolica de Chile, Marcoleta 367, Santiago Centro, RM, 8330024, Chile
  3. Department of Surgery, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
  
• ISSN：1364-8535

文摘

Introduction Light before and during acute illness has been associated with both benefit and harm in animal models and small human studies. Our objective was to determine the associations of light duration (photoperiod) and intensity (insolation) before and during critical illness with hospital mortality in ICU patients. Based on the 'winter immunoenhancement' theory, we tested the hypothesis that a shorter photoperiod before critical illness is associated with improved survival. Methods We analyzed data from 11,439 patients admitted to 8 ICUs at the University of Pittsburgh Medical Center between June 30, 1999 and July 31, 2004. Daily photoperiod and insolation prior to and after ICU admission were estimated for each patient by using data provided by the United States Naval Observatory and National Aeronautics and Space Administration and direct measurement of light gradient from outside to bedside for each ICU room. Our primary outcome was hospital mortality. The association between light and risk of death was analyzed using multivariate analyses, adjusting for potential confounders, including severity of illness, case mix, and ICU type. Results The cohort had an average APACHE III of 52.9 and a hospital mortality of 10.7%. In total, 128 ICU beds were analyzed; 108 (84%) had windows. Pre-illness photoperiod ranged from 259 to 421 hours in the prior month. A shorter photoperiod was associated with a reduced risk of death: for each 1-hour decrease, the adjusted OR was 0.997 (0.994 to 0.999, p = 0.03). In the ICU, there was near complete (99.6%) degradation of natural light from outside to the ICU bed. Thus, light exposure once in the ICU approached zero; the 24-hour insolation was 0.005 ± 0.003 kWh/m2 with little diurnal variation. There was no association between ICU photoperiod or insolation and mortality. Conclusions Consistent with the winter immunoenhancement theory, a shorter photoperiod in the month before critical illness is associated with a reduced risk of death. Once in the ICU, patients are exposed to near negligible natural light despite the presence of windows. Further studies are warranted to determine the underlying mechanisms and whether manipulating light exposure, before or during ICU admission, can enhance survival.