Introduction: Symptoms such as anxiety, confusion, disorientation and pain can be found in the majority of ICU patients, especially in those with delirium. Non-pharmacological strategies have been proven to be effective for the prevention and management of these symptoms. We developed a new concept for the design of ICU rooms. One part of this concept is a LED screen which extends from the head above the patient down to the patient's feet. The visual content of the LED screen is based on a computational design approach. Methods: The visual content was developed in three steps. The first step included a systematic literature search in MEDLINE: we searched for studies that investigated the effects of visual stimuli on the symptoms mentioned above. The second step included consensus meetings with intensivists, sleep specialists, psychologists, nurses, architects and computational designers. This interdisciplinary team made final decisions regarding the visual properties of the content on the basis of the literature search. The third step was devoted to technical development. Results: Of 1,760 citations, 70 were considered for full text review (53 observational studies, 17 randomized controlled trials (RCTs). These studies included healthy volunteers, medical and surgical non-ICU patients, outpatients and patients with dementia or mental disorders. Study results revealed that specific visual inputs can be effective in the reduction of pain, anxiety and disorientation: Patients with a hospital window view of greenery, environmental stimuli including light and nature scenes or patients solely exposed to nature images and green color had less pain, less anxiety and shorter hospital stay. As disorientation affects the majority of ICU patients, we decided to use the sky as a basic layer which changes color based on the time of the day. In terms of symptom complexity and diversity we decided to use parameterized visualizations: Instead of playing back pre-recorded animations, the visual content will be driven by predefined parameters. These predefined parameters include the results of routine pain, anxiety, sedation and delirium monitoring with validated scores. Conclusions: Interventions involving visual content appear to provide benefit for patients experiencing pain, anxiety and disorientation. RCTs are needed to assess the efficacy and tolerability of these interventions in critically ill patients.
© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins