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Recent studies conducted in patients with or without acute brain injury suggest no clear association between natural light exposure and mortality, functional outcome or costs of in-hospital care. Other mechanisms such as reduced views of natural surroundings or direct alerting effects of light may also play a role. Loss of exposure to natural light is associated with circadian rhythm disruption that may impact delirium burden and outcomes in the critically ill. It remains unclear whether intensive care environment affects the course of delirium and outcomes.
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The use of the multicomponent ABCDEF bundle (i.e., the assessment, prevention, and management of pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium assessment, early mobility and exercise, and family engagement and empowerment) was shown to be associated with significant and clinically meaningful improvements in outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition. Potentially modifiable factors for delirium are scarce and include non-environmental factors, i.e., benzodiazepine exposure and blood transfusion. Risk factors include mainly non-modifiable factors, i.e., greater age and dementia, prior coma, pre-ICU emergency surgery or trauma, and severity of illness. Delirium in the ICU is associated with adverse outcomes, higher ICU and hospital length of stay and costs, and a higher risk of cognitive impairment in survivors. It is characterized by a disturbance of attention with a change in cognition and a fluctuating course, with or without associated hyperactive symptoms (i.e., agitation and hallucinations), the hypoactive phenotype being much more prevalent than the hyperactive one in recent studies conducted in ICU patients. Delirium is a common complication in the ICU, occurring in up to 80% of invasively mechanically ventilated patients.