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Studies have demonstrated that changes in serum cholinesterase activities are associated with a higher incidence of delirium in critically ill patients. Additionally, basic research indicates that the cholinergic and circadian systems are interconnected, with each system influencing the functionality of the other. This data analysis of a proof-of-concept pilot study investigates whether modification in ICU design, including dynamic light therapy, may influence the circadian oscillation of serum cholinesterase activities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We enrolled adult critically ill patients who were on mechanical ventilation and had an anticipated ICU stay of at least 48\u00a0h. The patients were treated in either modified or standard ICU rooms. The modified rooms received extensive architectural modifications, including a new dynamic lighting system. Serum acetylcholinesterase and butyrylcholinesterase activities were measured every four hours for up to three 24-h assessment periods.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We included 64 patients in the data analysis (<jats:italic>n<\/jats:italic> = 34 patients in modified rooms,<jats:italic> n<\/jats:italic> = 30 in standard rooms). The median values of serum acetylcholinesterase and butyrylcholinesterase activities showed different patterns. Acetylcholinesterase activities differed significantly between the groups during the first assessment period (<jats:italic>p<\/jats:italic> = 0.04) and the second assessment period (<jats:italic>p<\/jats:italic> = 0.045). The intensity of light, as quantified by the effective circadian irradiance, significantly influenced the activities of acetylcholinesterase and butyrylcholinesterase throughout all assessment periods for patients in both groups (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). The analysis showed significant interaction (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), indicating that the differences in acetylcholinesterase and butyrylcholinesterase activities between the groups were inconsistent over time but apparent during specific periods of the day.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Implementing a comprehensive set of changes to the design of ICU rooms, including a dynamic lighting system, may influence the course of the activity patterns of acetylcholinesterase and butyrylcholinesterase in critically ill patients. Modifications to environmental factors could potentially offer neuroprotective benefits and facilitate the realignment of circadian rhythms within the cholinergic system.<\/jats:p>\n                <jats:p><jats:italic>Clinical trial registration<\/jats:italic> ClinicalTrials.gov: NCT02143661. Registered May 21, 2014.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40635-024-00709-5","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T16:22:41Z","timestamp":1734970961000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Modification in ICU design may influence circadian serum cholinesterase activities: a proof-of-concept pilot study"],"prefix":"10.1186","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct02143661","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Sebastian","family":"Schmidt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Heinrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus-Dieter","family":"Wernecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Spies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hancke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anika","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-1809","authenticated-orcid":false,"given":"Alawi","family":"Luetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"issue":"2","key":"709_CR1","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.bbr.2010.11.039","volume":"221","author":"RA Hut","year":"2011","unstructured":"Hut RA, Van der Zee EA (2011) The cholinergic system, circadian rhythmicity, and time memory. 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Written informed consent was obtained from all the patients or their authorized surrogates after ICU admission; if consent was initially obtained from a surrogate, we obtained consent from the patient once he or she was deemed to be legally competent. All procedures were followed under the ethical standards of Charit\u00e9\u2019s Ethics Committee on humans and with the Helsinki Declaration of 1975.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"A.L. reports personal fees from Avanos Medical, Dr\u00e4gerwerk AG KGaA, Dr. Franz K\u00f6hler Chemie GmbH, Hill-Rom Holdings and Philips Healthcare outside the submitted work. He reports a grant from Philips Healthcare outside the submitted work which was paid into departmental funds and Charit\u00e9 Clinician Scientist Program. C.S. (inventor) and A.L. (inventor) report issued patents related to the submitted work: European Patent 3 174 589 from July 31, 2015, European Patent 3 174 588 from July 31, 2015 and US Patent US 2017\/0224950 A1 from August 10, 2017. The remaining authors have disclosed that they do not have any potential competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"120"}}