Incidence of Intensive Care Unit Delirium After Heart Surgery: A Feasibility Study of a Forest Environment Intervention.
6 affiliations
- 1Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
- 2Division of Anesthesiology and Intensive Care, Medical University of Graz, Graz, Austria.
- 3Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
- 4Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany.
- 5Vivisol - Heimbehandlungsgeräte GmbH, Vienna, Austria.
- 6Clinical Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.
Abstract
Background
Postoperative delirium is a serious complication in intensive care units (ICUs), particularly following cardiac surgery. It is associated with circadian rhythm disruption, sleep disturbances and adverse outcomes. ICU environments often lack natural time cues, which may exacerbate circadian misalignment and increase delirium risk.Aim
The primary aim of the study was the evaluation of the implementation of two chronotherapeutic ICU interventions regarding recruitment, implementability and safety. Its secondary aim was to descriptively assess postoperative delirium across intervention groups.Study design
This randomized feasibility study was conducted in a tertiary cardiac surgery ICU in Austria. Adult patients undergoing elective cardiac surgery were allocated to one of three groups: (1) forest environment, (2) light exposure or (3) standard ICU care. Interventions were applied for 12 h daily. Delirium was assessed at three postoperative time points using the confusion assessment method for the ICU (CAM-ICU) and intensive care delirium screening checklist (ICDSC).Results
This study was conducted between March 2020 and 2025. Seventy-seven patients were enrolled, and 64 remained in the final analytical cohort. Interventions were delivered within routine care. Patients and ICU staff did not report intervention-related concerns. Implementation challenges included ICU restructuring, patient transfers due to COVID-19 and deviations from randomized allocation because of operational constraints. No intervention-related adverse events occurred. Delirium assessments were limited at several time points because of sedation, early ICU discharge or transfer. Across all groups, postoperative delirium was detected in 5 of 130 CAM-ICU completed assessments (3.8%) and 8 of 115 ICDSC completed assessments (6.9%), precluding inferential group comparisons.Conclusions
Chronotherapeutic environmental interventions were feasible and safe in ICU care. Feasibility results highlighted challenges related to ICU logistics, sedation-related assessment limitations and pandemic-related disruptions. The unexpectedly low delirium incidence limited conclusions regarding intervention efficacy. Future trials should include larger high-risk populations and prospectively defined feasibility outcomes.Relevance to clinical practice
Optimized ICU environments, including noise reduction and light management, may support delirium prevention. Chronotherapeutic environmental interventions are feasible additions to routine ICU care.
Related
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- Population-based incidence rate of in-hospital delirium in older adults in Norway—a HUNT study
- Commentary: Incidence and independent risk factors for postoperative delirium in ICU patients after cardiopulmonary bypass cardiac surgery: a retrospective cohort study
- Closing the Gap Between Risk and Recognition: Improving Delirium Screening in the Pediatric Intensive Care Unit.
BibTeX
@article{wagnerskacel2026incidence,
title = {{Incidence of Intensive Care Unit Delirium After Heart Surgery: A Feasibility Study of a Forest Environment Intervention.}},
author = {Jolana Wagner-Skacel and Michael Schörghuber and Christoph Kumpitsch and Paul Skacel and Tatjana Stross and Emma Miksch and René Pilz and Christiane D'Avia and Marilena Wilding and Emanuel Jauk and Dion Lamprecht and Andreas Brandstätter and Lena Stanschus and Konstantin Reininghaus and Nina Dalkner and Sabrina Mörkl and Eva Z Reininghaus and Angela Horvath and Susanne Bengesser},
journal = {Nursing in critical care},
year = {2026},
month = oct,
doi = {10.1111/nicc.70742},
url = {https://europepmc.org/article/MED/42952074},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Incidence of Intensive Care Unit Delirium After Heart Surgery: A Feasibility Study of a Forest Environment Intervention.
AU - Jolana Wagner-Skacel
AU - Michael Schörghuber
AU - Christoph Kumpitsch
AU - Paul Skacel
AU - Tatjana Stross
AU - Emma Miksch
AU - René Pilz
AU - Christiane D'Avia
AU - Marilena Wilding
AU - Emanuel Jauk
AU - Dion Lamprecht
AU - Andreas Brandstätter
AU - Lena Stanschus
AU - Konstantin Reininghaus
AU - Nina Dalkner
AU - Sabrina Mörkl
AU - Eva Z Reininghaus
AU - Angela Horvath
AU - Susanne Bengesser
PY - 2026
DA - 2026/10/28
JO - Nursing in critical care
DO - 10.1111/nicc.70742
UR - https://europepmc.org/article/MED/42952074
AB - Background Postoperative delirium is a serious complication in intensive care units (ICUs), particularly following cardiac surgery. It is associated with circadian rhythm disruption, sleep disturbances and adverse outcomes. ICU environments often lack natural time cues, which may exacerbate circadian misalignment and increase delirium risk.Aim The primary aim of the study was the evaluation of the implementation of two chronotherapeutic ICU interventions regarding recruitment, implementability and safety. Its secondary aim was to descriptively assess postoperative delirium across intervention groups.Study design This randomized feasibility study was conducted in a tertiary cardiac surgery ICU in Austria. Adult patients undergoing elective cardiac surgery were allocated to one of three groups: (1) forest environment, (2) light exposure or (3) standard ICU care. Interventions were applied for 12 h daily. Delirium was assessed at three postoperative time points using the confusion assessment method for the ICU (CAM-ICU) and intensive care delirium screening checklist (ICDSC).Results This study was conducted between March 2020 and 2025. Seventy-seven patients were enrolled, and 64 remained in the final analytical cohort. Interventions were delivered within routine care. Patients and ICU staff did not report intervention-related concerns. Implementation challenges included ICU restructuring, patient transfers due to COVID-19 and deviations from randomized allocation because of operational constraints. No intervention-related adverse events occurred. Delirium assessments were limited at several time points because of sedation, early ICU discharge or transfer. Across all groups, postoperative delirium was detected in 5 of 130 CAM-ICU completed assessments (3.8%) and 8 of 115 ICDSC completed assessments (6.9%), precluding inferential group comparisons.Conclusions Chronotherapeutic environmental interventions were feasible and safe in ICU care. Feasibility results highlighted challenges related to ICU logistics, sedation-related assessment limitations and pandemic-related disruptions. The unexpectedly low delirium incidence limited conclusions regarding intervention efficacy. Future trials should include larger high-risk populations and prospectively defined feasibility outcomes.Relevance to clinical practice Optimized ICU environments, including noise reduction and light management, may support delirium prevention. Chronotherapeutic environmental interventions are feasible additions to routine ICU care.
SN - 1362-1017
SN - 1478-5153
ER -