Stabilization of Circadian Rhythms in Delirious ICU Patients Through Light Intervention

Prevalence of physiological circadian rhythmicity measured by serum melatonin concentrations.

Prevalence of physiological circadian rhythmicity measured by expression activity of clock genes.

Prevalence of physiological circadian rhythmicity measured by metabolomic concentrations.

Prevalence of physiological circadian rhythmicity measured by proteomic concentrations.

Prevalence of physiological circadian rhythmicity measured by inflammation parameters (cytokines, chemokines, extracellular mitochondria concentrations.

Delirium will be measured with the Confusion Assessment Method for the intensive care unit (CAM-ICU), Binary scale (Positive/Negative)

Delirium-free days will be measured in day without positive delirium scoring (Confusion Assessment Method for the intensive care unit (CAM-ICU), Binary scale (Negative))

Delirium severity will be measured with the Intensive Care Delirium Screening Checklist (ICDSC). The higher the score the worse - higher score = higher delirium severity(ICDSC)

Level of sedation will be measured with the Richmond Agitation-Sedation-Scale (RASS), -5 to +4, negative scores translates to a higher degree of sedation.

Severity of pain will be measured with the Numeric Rating Scale (NRS). A higher score corresponds to a higher severity of pain.Score values from 0 to 10. A higher score means worse outcome.

Severity of pain will be measured with the Visualized Numeric Rating Scale (NRS-V). A higher score corresponds to a higher severity of pain.Score values from 0 to 10. A higher score means worse outcome.

Severity of pain will be measured with the Faces Pain Scale-Revised (FPS-R). A higher score corresponds to a higher severity of pain.Score values from 0 to 10. A higher score means worse outcome.

Severity of pain will be measured with the Behavioral Pain Scale (BPS) . A higher score corresponds to a higher severity of pain.Score values from 3 to 12. A higher score means worse outcome.

Severity of pain will be measured with the Behavioral Pain Scale for Non- Intubated (BPS-NI). A higher score corresponds to a higher severity of pain. A higher score corresponds to a higher severity of pain.Score values from 3 to 12. A higher score means worse outcome.

Total amount of opioids administered per ICU treatment day will be measured in with morphine equivalents for each administered opioids.

Total amount of sedatives administered per ICU treatment day by dose summation for each sedative.

Duration of invasive and non-invasive ventilation in hours

ICU length of stay will be measured in days

Hospital length of stay will be measured in days

Does patient fulfil sepsis criteria (Yes/No)

Does patient fulfil criteria for septic shock (Yes/No)

Predicts ICU mortality based on lab results and clinical data. . Score values between 0 and max. 24. Higher scores mean worse outcome.

Estimates mortality in ICU patients, comparable to APACHE II.Score values between 0 and max. 163. Higher scores mean worse outcome.

The Simplified Therapeutic Intervention Scoring System TISS-28 consists of 28 items. It is intended to accurately measure the level of care required for a patient in the Intensive Care Unit (ICU). Score values between 0 and max. 78. Higher scores mean higher level of required care for ICU patients.

The Acute Physiology and Chronic Health Evaluation (APACHE II) is a severity score and mortality estimation tool developed from a large sample of ICU patients in the United States.. Score values between 0 and max. 71. Higher scores mean worse outcome.

The muscle scale grades muscle power on a scale of 0 to 5 (5= Muscle contracts normally against full resistance.; 0 = No movement is observed).

Hand grip strength is measured with a dynometer.

To record the patient's highest level of mobility in the Intensive Care Unit. Scale from 0 to 10. 0 meaning no movement and 10 mean walking independently.

FIM™ is comprised of 18 items, grouped into 2 subscales - motor and cognition. Each item is scored on a 7 point ordinal scale, ranging from a score of 1 to a score of 7. The higher the score, the more independent the patient is in performing the task associated with that item

Plasma glucose (PG) levels are determined by taking a blood sample from participants. It can be measured in mg/dL.

Blood glucose variability (SD in mg/dl) represents how much glucose levels fluctuate over time from a given average.

Blood glucose levels outside the ranges listed in the blood sugar levels chart by age above are categorized as either high or low blood sugar.

The amount of insuline is measured in units (IU).

Binary scale (Positive/Negative). Diagnosis of "PICS" is defined by a new impairment or worsening of the health condition after intensive care unit stay and a clinically significant distress in at least one of the following outcome measurement instruments: Patient Health Questionnaires (PHQ-9, PHQ-8, PHQ-4), Generalized Anxiety Disorder Scales (GAD-2 and GAD-7), Impact of Event Scale Revised (IES-R), MiniCog, Animal Naming Test, Trail Making Test (TMT-A, TMT-B), Repeatable Battery for the Assessment of Neuropsychological Satus (RBANS), Timed Up-and-Go (TUG), Handgrip Strength, EQ-5D-5L, subjective assessment NRS, WHO Disability Assessment Schedule (WHODAS), Short Physical Performance Battery (SPPB).

Binary scale (Positive/Negative). All participants will be undergoing a polysomnography in the St. Hedwig hospital.

All participants will be undergoing a polysomnography one night in the Intensive Care Unit.

In this questionnaire, the typical sleep behaviour over the past 4 week will be reported

Aktigraphy is measured by ActLumus in a time period of six weeks.

Sleep parameter are documented by a sleep diary in a time period of six weeks.

Molecular data from muscle needle biopsies in the morning and evening on a study day

Physiotherapy is measured by a questionnaire.

Nutritional Therapy is measured by chart review.

Nutritional Therapy Complications are measured by chart review.

Rate in patient days on which the target protein intake was achieved

Rate of days with adherence to the diet plan (yes/no)

Composition of the administered food is measured by macro- and micronutrients according to documentation

Daily feeding breaks are measured in hours

Weather data are extracted from German Wheather Administration and Federal Environment Agency.

Cognition 1 is measured by MiniCog

Cognition 2 is measured by Animal Naming Test

Cognition 3 is measured by Trail Making Tests A&B

Mental impairments are measured using the PHQ-4. The PHQ-4 (Patient Health Questionnaire-4) is a brief, 4-item self-report tool screening for anxiety and depression symptoms, combining the PHQ-2 (depression) and GAD-2 (anxiety) scales, with scores from 0-12 indicating increasing symptom severity (Normal: 0-2, Mild: 3-5, Moderate: 6-8, Severe: 9-12). Each item asks how often in the last two weeks you've been bothered by something, with responses 0 (not at all) to 3 (nearly every day), and scores ≥3 on the first two items suggest depression, while ≥3 on the last two suggest anxiety, warranting further clinical assessment.

Quality of life 1 is measured by EQ-5D-5L. The EQ-5D-5L is a widely used patient-reported outcome (PRO) tool measuring health-related quality of life with five dimensions (Mobility, Self-care, Usual Activities, Pain/Discomfort, Anxiety/Depression), each having five severity levels (no to extreme problems) An EQ-5D-5L result describes health status in 5 dimensions on a 5-point scale (none to extreme problems) and is summarized into a single index value (usually 0 to 1), with 1 representing perfect health, supplemented by a visual analog scale (EQ VAS) value for self-assessment of health.

Quality of life 2 is measured by WHODAS 2.0. The WHODAS (World Health Organization Disability Assessment Schedule) 2.0 12-item version is a standardized, cross-cultural tool measuring health and disability by assessing difficulties in six core domains (cognition, mobility, self-care, getting along, life activities, participation) over the past 30 days, and contains 2 questions per domain. WHODAS 2.0 uses a 1-5 Likert scale (none to extreme difficulty) for its items, with scores summed and converted to a 0-100 standardized score (higher is worse), offering simple addition for general scoring or complex Item Response Theory (IRT) for weighted domain scores, with a threshold of >10 (12-item) indicating top 10% disability, all to assess disability across six domains.

Mortality is measured by statistical data.

Relevant clinical data (routine and study data), which are associated with circadian rhythmicity