The DAYDREAM Study

A wide range of life-threatening illnesses lead to treatment in intensive care units (ICUs). For those who start to recover but are still very sick, it is very common to experience delirium. Delirium is a distressing and real experience, which many critical illness survivors describe as the worst part of their illness. For patients who have been on a breathing machine, 4 out of 5 can end up suffering from delirium. It is an experience that increases the chances of developing post-traumatic stress disorder.

We want to find out whether making a simple change to how we feed patients in an ICU who are so unwell they need to be on a breathing machine means they are less likely to suffer from delirium when they are starting to recover. It is standard to give people on a breathing machine their food as a liquid, through a tube in the stomach. This feed is normally given constantly over 24 hours. We think this might be upsetting to the normal body clock and natural body rhythms, which might lead to delirium.

It is known that in animals, timing feeding to the daytime will align the body clock, but we don’t know whether this is also true in critically ill people.

However, we do know that when body clock hormones are disrupted, people are more likely to suffer delirium. There is uncertainty over the benefits of feeding only in the day, but it is a promising way of potentially reducing delirium. Other studies have been done, including in critically ill children, that show that feeding for 12 hours in the day and not at night is safe. If this small study shows it's possible to feed only in the day and to measure the rate of delirium, the plan would be to go on to conduct a much larger study in the future. If found to be effective in reducing delirium, daytime only feeding should be easy to implement throughout ICUs in the NHS and be cost-neutral.

We propose conducting a trial to enrol 40 patients from two UK ICUs to determine the feasibility of day-time feeding. Eligible patients will be randomly allocated to either day-time feeding or standard continuous feeding (day and night). We will compare information from participants in the trial that will allow us to decide whether the trial has been successful.

We have planned this study by working with ex-ICU patients. If the study goes ahead, we will continue to work with ex-ICU patients throughout the study and share the results with those patients who have been enrolled into the study. The study and its results would then be submitted for publication in a UK peer-reviewed publication.