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

This consensus roadmap outlines a strategic framework for incorporating circadian medicine into intensive care unit (ICU) environments. Formulated via an international expert workshop, it comprises 6 core propositions and 16 key recommendations structured around developing circadian biomarkers, defining core outcome sets, optimizing clinical trial designs, and establishing implementation and educational strategies.

Patients in the ICU suffer from severe circadian disruptions caused by the ICU environment (continuous artificial light, noise, lack of natural daily cues) and standard medical interventions (sedatives, continuous nutrition). These disruptions are associated with worse clinical outcomes and delayed recovery. While targeting circadian health is highly promising, translation requires addressing evidence gaps and establishing robust study frameworks.

This consensus roadmap represents the initial publication of a unified global strategy for translating circadian biology principles into ICU clinical practice.