Enhancing circadian rhythms—the circadian MEGA bundle as novel approach to treat critical illness

Jul 5, 2023Annals of translational medicine

Strengthening Body Clocks with a New Combined Treatment to Help Critically Ill Patients

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Abstract

Circadian rhythms are essential to physiological homeostasis and are often disrupted in the intensive care unit (ICU).

Disruption of circadian rhythms in the ICU may contribute to increased morbidity and mortality in critically ill patients.
Maintaining circadian rhythms is particularly important for bed-bound patients in the ICU.
Enhancing the amplitude of circadian cycles is associated with significant improvements in health and wellbeing.
Novel strategies, including a MEGA bundle of therapies, could potentially restore and enhance circadian rhythms in critical illness.
The MEGA bundle includes intense light therapy, cyclic nutrition, timed physical therapy, nighttime melatonin, rhythm amplitude enhancers, temperature control, and sleep hygiene.

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Circadian rhythms are essential to physiological homeostasis, but often disrupted in the intensive care unit (ICU) due to the absence of natural zeitgebers and exposure to treatments which affect circadian regulators. This is increasingly recognized as a contributor to morbidity and mortality across a variety of medical conditions including critical illness. Maintenance of circadian rhythms is particularly relevant to critically ill patients, who are restricted not only to the ICU environment but often bed bound. Circadian rhythms have been evaluated in several ICU studies, but effective therapies to maintain, restore, or amplify circadian rhythms have not been fully established yet. Circadian entrainment and circadian amplitude enhancement are integral to patients' overall health and well-being, and likely even more important during response to and recovery from critical illness. In fact, studies have shown that enhancing the amplitude of circadian cycles has significant beneficial effects on health and wellbeing. In this review, we discuss up-to-date literature on novel circadian mechanism that could not only restore but enhance circadian rhythms in critical illness by using a MEGA bundle consisting of intense light therapy each morning, cyclic nutrition support, timed physical therapy, nighttime melatonin administration, morning administration of circadian rhythm amplitude enhancers, cyclic temperature control and a nocturnal sleep hygiene bundle.

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Enhancing circadian rhythms—the circadian MEGA bundle as novel approach to treat critical illness

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