Table 2 Suggested chronobiological approaches to preserve circadian rhythms on the intensive care unit (ICU)
From: Clinical chronobiology: a timely consideration in critical care medicine
Zeitgeber | Ideal ICU environment |
|---|---|
Light | • Bright-light daylight hours (> 1000 lx) • Minimise light pollution at night (< 1 lx, consider) • Eye masks at night |
Feeding | • Intermittent daytime feeding aligned to usual meal times • Avoid continuous and overnight feeding |
Temperature | • Warmer environment during the day and cooler at night |
Exercise rehabilitation | • Similar time each day • Take patient chronotype into consideration when planning schedule |
Noise | • Minimise noise during the night time • Ear plugs at night |
Medical and nursing interventions | • Minimise at night and cohort together • For non-sedated patients, allow patients to sleep according to their natural schedule, rather than a staff-based schedule |
Sedative drugs | • Minimise use through regular review and avoid “sleeping tablets” • Consider melatonin (up to 5 mg) at 0900 h as circadian preserving sleep aide • When possible, give drugs at the time of day least disturbing to circadian rhythms |