Daily Anesthesiology Research Analysis

BACKGROUND: Light is a key regulator of circadian rhythms, sleep, and neuroendocrine function. Abnormal light exposure has been associated with delirium and adverse outcomes in critically ill patients. While previous ICU studies have generally reported low daytime illuminance and intermittent nocturnal light exposure, most relied on averaged measurements or low temporal resolution monitoring, potentially obscuring clinically relevant exposure patterns. In routine ICU care, light exposure often occurs as brief but frequent events related to necessary interventions, yet the extent and temporal structure of such light fragmentation remain poorly characterized. This study therefore aimed to characterize high-resolution 24-hour light exposure patterns and nocturnal fragmentation in ICU patients. METHODS: In this observational study, ambient illuminance was continuously recorded every 5 s in adult ICU patients over a one-year period. A total of 222 patients were monitored for up to 7 consecutive days, yielding more than 14 million individual measurements. Light exposure was analysed across complete 24-hour cycles and stratified into daytime (07:00-20:59) and nighttime (21:00-06:59) periods. Outcomes included median illuminance, frequency of light events, extreme illuminance (99th percentile), and duration of uninterrupted nocturnal darkness. Mixed-effects models and negative binomial regression were used to account for repeated measurements and to assess associations with room configuration. RESULTS: Across the 24-hour cycle, median illuminance demonstrated a flattened diurnal pattern, with daytime light levels remaining markedly below those typically encountered in indoor working environments and limited sustained darkness at night. Nighttime exposure was dominated by frequent short-duration light events, resulting in pronounced fragmentation of nocturnal darkness. Fragmentation patterns were largely independent of room configuration and treatment intensity, as ambient illuminance did not differ according to organ support modality once time of day was considered. Extreme illuminance values occurred intermittently, predominantly during daytime, and varied according to room type. CONCLUSIONS: ICU light exposure is characterized primarily by temporal fragmentation rather than sustained brightness. Repeated interruptions of darkness may represent a plausible environmental mechanism contributing to circadian dysregulation. These findings highlight care processes as a key target for interventions and support the use of fragmentation-based metrics in future circadian research in critical care.

Due to the continued use of fossil fuels and other chemical pollutants, atmospheric greenhouse gas concentrations and environmental pollution continue to rise. The health sector is both a driver and a victim of these developments, and intensive care medicine (ICM), with its high energy demands, extensive use of disposable products, and large variety of pharmaceuticals, contributes substantially to the climate crisis and environmental degradation. The European Society of Anaesthesiology and Intensive Care (ESAIC) therefore aimed to develop consensus recommendations to reduce the environmental footprint of ICM across Europe. A total of 37 recommendations were initially drafted by four topic groups (1) energy, (2) waste management, (3) medication, and (4) ethics-each composed of three to five experts. To facilitate implementation in both middle- and high-income European countries, the agreement threshold was set at 80%. The recommendations were validated by 37 experts from 20 countries using a two-step Delphi procedure. In the first round, all recommendations reached at least 75% agreement. After amendments to four recommendations based on expert feedback, all achieved over 80% approval in the second round, with 32 receiving more than 90% agreement. The final recommendations address: (1) a complete transition to renewable energy and implementation of energy-saving strategies; (2) optimisation of procurement in clinical processes (10Rs) and waste management solutions for single-use plastics; (3) reduction of greenhouse gas emissions (mainly fluorinated gases) and water toxicity caused by medications, as well as prevention of a further increase in antimicrobial resistance (AMR); and (4) implementation of an environment-related, ethically guided precautionary principle. This ESAIC consensus provides a practical framework for sustainable ICM. Stakeholders at all levels should now introduce these recommendations through institutional policies, procurement criteria, guidelines and quality improvement programmes to align intensive care practice with planetary health goals.

OBJECTIVE: To determine whether Dermabond (2-octyl cyanoacrylate) provides superior lead stability to suture for percutaneous spinal cord stimulator (SCS) trial leads, and whether migration reflects patient-level factors rather than anchoring method. DESIGN: Prospective, randomized, within-patient controlled trial (ClinicalTrials.gov NCT05914311). SETTING: Interventional Pain and Spine Medicine Center at an academic medical center. SUBJECTS: Forty-eight adults (96 leads) undergoing bilateral thoracic percutaneous SCS trial implantation. METHODS: Within each patient, one lead was randomized to Dermabond and the contralateral lead to suture. The primary outcome was absolute radiographic lead migration (mm) between placement and end-of-trial, both imaged upright. All analyses accounted for within-patient correlation; a post hoc non-inferiority framing used the a priori 9 mm clinically meaningful threshold. RESULTS: Mean absolute migration was 9.15 ± 14.49 mm (Dermabond) and 10.60 ± 17.42 mm (suture); the paired difference was -1.46 mm (95% CI, -6.73 to 3.81; p = 0.58), with the upper bound well below the 9 mm threshold. In adjusted analyses, male sex (+8.17 mm; p = 0.036) and prior spine surgery (+7.08 mm; p = 0.048) predicted greater migration; BMI, age, and fixation method did not. Clinically significant (≥9 mm) migration occurred in 27.1% of Dermabond and 22.9% of suture leads (McNemar p = 0.77). CONCLUSIONS: Dermabond was not superior to suture but showed clinically comparable stability, supporting it as a noninvasive alternative. The stronger signal was at the patient level: Male sex and prior spine surgery, but not BMI, predicted migration. Future efforts to reduce migration should target patient-level drivers rather than anchor choice.