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Delirium Variability is Influenced by the Sound Environment (DEVISE Study): How Changes in the Intensive Care Unit soundscape affect delirium incidence

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Abstract

Quantitative data on the sensory environment of intensive care unit (ICU) patients and its potential link to increased risk of delirium is limited. We examined whether higher average sound and light levels in ICU environments are associated with delirium incidence. Over 111 million sound and light measurements from 143 patient stays in the surgical and trauma ICUs were collected using Quietyme® (Neshkoro, Wisconsin) sensors from May to July 2018 and analyzed. Sensory data were grouped into time of day, then normalized against their ICU environments, with Confusion Assessment Method (CAM-ICU) scores measured each shift. We then performed logistic regression analysis, adjusting for possible confounding variables. Lower morning sound averages (8 am-12 pm) (OR = 0.835, 95% OR CI = [0.746, 0.934], p = 0.002) and higher daytime sound averages (12 pm–6 pm) (OR = 1.157, 95% OR CI = [1.036, 1.292], p = 0.011) were associated with an increased odds of delirium incidence, while nighttime sound averages (10 pm-8 am) (OR = 0.990, 95% OR CI = [0.804, 1.221], p = 0.928) and the ICU light environment did not show statistical significance. Our results suggest an association between the ICU soundscape and the odds of developing delirium. This creates a future paradigm for studies of the ICU soundscape and lightscape.

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Acknowledgments

The authors would like to thank Russ Beebe, interactions designer within the Department of Anesthesiology at Vanderbilt University Medical Center, for his assistance formatting figures.

Code availability

By request to the corresponding author.

Funding

Quietyme® provided the sensors free of charge. They had no input on the study design, data interpretation, and were not involved with the writing or revising of the manuscript. Dr. Robert Freundlich received funding from NHLBI 1K23HL148640 and NCATS 1KL2TR002245. All other authors have no sources of funding to report.

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Author notes

  1. Ayush Sangari and Elizabeth A. Emhardt contributed equally to this work.

Authors and Affiliations

  1. Department of Electrical Engineering and Computer Science, Vanderbilt University, 2301 Vanderbilt Place, PMB 351679, Nashville, TN, 37235, USA

    Ayush Sangari

  2. Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, 1211 21st Avenue South, MAB 422, Nashville, TN, 37212, USA

    Elizabeth A. Emhardt, Robert E. Freundlich & Joseph J. Schlesinger

  3. The Newcastle upon Tyne NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne, Tyne and Wear, NE7 7DN, UK

    Barbara Salas

  4. Department of General Surgery, Trauma and Burn Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA

    Andrew Avery

  5. Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, TN, 37203, USA

    Robert E. Freundlich & Daniel Fabbri

  6. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN, 37203, USA

    Matthew S. Shotwell

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Correspondence to Elizabeth A. Emhardt.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Vanderbilt University Institutional Review Board on April 16, 2018, IRB #180053.

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Sangari, A., Emhardt, E.A., Salas, B. et al. Delirium Variability is Influenced by the Sound Environment (DEVISE Study): How Changes in the Intensive Care Unit soundscape affect delirium incidence. J Med Syst 45, 76 (2021). https://doi.org/10.1007/s10916-021-01752-5

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