Evidence map›Paper›PMID 41429288›Full record

GuidelineChest2026

Challenges and Recommendations for Integrating Circadian Medicine in Critical Care: A Roadmap.

Floor W Hiemstra, Liliana Bustos González, Lilian J Engelhardt, Laura Hancke, Luisa K Pilz, Amanda I Adler, Hassan S Dashti, Xavier Drouot, Gareth B Kitchen, Melissa P Knauert and 14 more

Abstract readReviewPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Chest, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Floor W HiemstraDepartment of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands; Group of Circadian Medicine, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands.
Liliana Bustos GonzálezSchool of Nursing, Faculty of Medicine, Universidad de Valparaíso, Viña del Mar, Chile.
Lilian J EngelhardtDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin,corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; BIH Biomedical Innovation Academy, BIHCharité Junior Digital Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
Laura HanckeDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin,corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Luisa K PilzDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin,corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Amanda I AdlerOxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom.
Hassan S DashtiDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Xavier DrouotUniversity Hospital of Poitiers, Poitiers, France.
Gareth B KitchenDivision of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, United Kingdom.
Melissa P KnauertSection of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Achim KramerLaboratory of Chronobiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Jonathan O LiptonDivision of Sleep Medicine, Harvard Medical School, Boston, MA; Department of Neurology and Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA.
Alawi LuetzDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin,corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany.
Matthew B MaasDepartment of Neurology, Northwestern University, Chicago, IL; Department of Anesthesiology, Northwestern University, Chicago, IL.
Nathan M PajorDivision of Pulmonary Medicine, Cincinnati Children's Medical Center, Cincinnati, OH; Division of Biomedical Informatics, Cincinnati Children's Medical Center, Cincinnati, OH; James M. Anderson Center, Cincinnati Children's Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Sairam ParthasarathyUniversity of Arizona Center for Sleep Circadian and Neuroscience Research, University of Arizona, Tucson, AZ.
Claudia SpiesDepartment of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin,corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
David J van WesterlooDepartment of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
Matthias FeltenDepartment of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Elizabeth B KlermanDivision of Sleep Medicine, Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA.
David W RayOxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom; NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom; Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Kavli Centre for Nanoscience Discovery, University of Oxford, Oxford, United Kingdom.
Marc D RubenDivision of Pulmonary Medicine, Cincinnati Children's Medical Center, Cincinnati, OH; Division of Biomedical Informatics, Cincinnati Children's Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Till RoennebergChronsulting, Peterskirchen, Germany; Institute for Medical Psychology, LMU Munich, Munich, Germany; Institute and Polyclinic for Occupational, Social, and Environmental Medicine, LMU Munich, Germany.
Laura KervezeeGroup of Circadian Medicine, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: L.Kervezee@lumc.nl.

Funding

Mechanisms of Circadian and Synaptic Dysfunction After Repetitive Mild TBIRF1NS126547 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI LIPTON, JONATHAN OREN, WHALEN, MICHAEL J · 2022 to 2022
$2.4M
Investigating Circadian Mechanisms of Cellular Resilience: Rhythmic Condensates, Disorder, and StressR01HL151368 · NHLBI · BOSTON CHILDREN'S HOSPITAL · PI LIPTON, JONATHAN OREN · 2020 to 2024
$2.1M
NHLBI NIH HHS R01 HL151368NINDS NIH HHS RF1 NS126547
6 · The paper itself

Abstract

backgroundCircadian rhythms are often severely disrupted in critically ill patients in the ICU. The ICU environment, characterized by irregular light-dark signals, continuous nutrition, and round-the-clock interventions, contributes to this disruption by providing weak and conflicting timing cues to the circadian system. Extensive scientific research has demonstrated that circadian rhythms play a vital role in regulating physiology and maintaining overall health. Therefore, integrating circadian principles into critical care may represent a promising strategy to improve patient outcomes in the ICU. RESEARCH QUESTION: What are the key challenges of integrating circadian medicine into critical care, what steps can address these challenges, and which recommendations can guide future study designs and clinical implementation? STUDY DESIGN AND

methodsWe convened a 5-day workshop in September 2024 that brought together 24 international experts with backgrounds in circadian biology, critical care, and implementation science. Each day was organized around a predefined theme, with morning presentations and plenary discussions, and afternoons dedicated to drafting a list of Propositions and Recommendations in breakout groups. Propositions and Recommendations were finalized via a post-workshop survey requiring ≥ 75% agreement.

resultsThis roadmap summarizes the discussions and outcomes of the workshop, structured around a set of Propositions and Recommendations, and provides a framework for building a robust evidence base for integrating circadian principles into ICU practice. Key recommendations include the development of circadian outcome measures tailored for use in the ICU and using standardized frameworks for evaluating the effect of circadian interventions in clinical trials.

interpretationAltogether, this roadmap provides an interdisciplinary framework resulting from a collaborative effort of ICU clinicians, circadian biologists, and implementation specialists, for building a robust evidence base for integrating circadian principles into ICU research and practice.

Indexed as

Circadian RhythmCritical CareCritical IllnessHumansIntensive Care Unitscircadian rhythmscritical carecritical illnessICUmeeting report

Identifiers

PMID41429288
PMCPMC13083041

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.