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Intensive Care Medicine

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30.11.2018 | Systematic Review

The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis

verfasst von: Leona Bannon, Jennifer McGaughey, Rejina Verghis, Mike Clarke, Daniel F. McAuley, Bronagh Blackwood

Erschienen in: Intensive Care Medicine | Ausgabe 1/2019

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Abstract

Purpose

To evaluate the effect of non-pharmacological interventions versus standard care on incidence and duration of delirium in critically ill patients.

Methods

We searched electronic and grey literature for randomised clinical trials up to March 2018. Two reviewers independently screened, selected and extracted data. Meta-analysis was undertaken using random effects modelling.

Results

We identified 15 trials (2812 participants). Eleven trials reported incidence of delirium. Pooled data from four trials of bright light therapy showed no significant effect between groups (n = 829 participants, RR 0.45, 99% CI 0.10–2.13, P = 0.19, very low quality evidence). Seven trials of various individual interventions also failed to report any significant effects. A total of eight trials reported duration of delirium. Pooled data from two trials of multicomponent physical therapy showed no significant effect [n = 404 participants, MD (days) − 0.65, 99% CI − 2.73 to 1.44, P = 0.42, low quality of evidence]. Four trials of various individual interventions also reported no significant effects. A trial of family voice reorientation showed a beneficial effect [n = 30, MD (days) − 1.30, 99% CI − 2.41 to − 0.19, P = 0.003, very low quality evidence].

Conclusions

Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients. Future research should consider well-designed and well-described multicomponent interventions and include adequately defined outcome measures.

Nur mit Berechtigung zugänglich

Page VJ, Navarange S, Gama S, McAuley DF (2009) Routine delirium monitoring in a UK critical care unit. Crit Care 13:R16. https://doi.org/10.1186/cc7714 CrossRefPubMedPubMedCentral

Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762. https://doi.org/10.1001/jama.291.14.1753 CrossRefPubMed

Hopkins RO, Jackson JC (2006) Long term neurocognitive function after critical illness. Chest 130:869–878. https://doi.org/10.1378/chest.130.3.869 CrossRefPubMed

Pandharipande PP, Girard TD, Jackson JC et al (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316. https://doi.org/10.1056/NEJMoa1301372 CrossRefPubMedPubMedCentral

Mitchell ML, Shum DHK, Mihala G, Murfield JE, Aitken LM (2018) Long-term cognitive impairment and delirium in intensive care: a prospective cohort study. Aust Crit Care 31:204–211. https://doi.org/10.1016/j.aucc.2017.07.002 CrossRefPubMed

Lat I, McMillian W, Taylor S, Janzen JM, Papadopoulos S, Korth L, Ehtisham A, Nold J, Agarwal S, Azocar R, Burke P (2009) The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 37(6):1898–1905. https://doi.org/10.1097/CCM.0b013e31819ffe38 CrossRefPubMed

Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW (2005) Intensive care unit delirium is an independent predictor of longer hospital stay. A prospective analysis of 261 non-ventilated patients. Crit Care 9(4):R375–R381CrossRefPubMedPubMedCentral

Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM (2015) Posttraumatic stress disorder in critical illness survivors: a meta-analysis. Crit Care Med 43(5):1121–1129. https://doi.org/10.1097/CCM.0000000000000882 CrossRefPubMed

Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962. https://doi.org/10.1097/01.CCM.0000119429.16055.92 CrossRefPubMed

10.

MacSweeney R, Barber V, Page V, Ely EW, Perkins GD, Young JD, McAuley DF (2010) A national survey of the management of delirium in UK intensive care units. Q J Med 103(4):243–251. https://doi.org/10.1093/qjmed/hcp194 CrossRef

11.

Devlin JW, Bhat S, Roberts RJ, Skrobik Y (2011) Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states. Ann Pharmacother 45:1217–1229. https://doi.org/10.1345/aph.1Q332 CrossRefPubMed

12.

Page VJ, Ely EW, Gates S, Zhao XB, Alce T, Shintani A, Jackson J, Perkins GD, McAuley DF (2013) Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med 1(7):515–523. https://doi.org/10.1016/S2213-2600(13),70166-8 CrossRefPubMedPubMedCentral

13.

van den Boogaard M, Slooter AJC, Bruggermann RJM, The REDUCE Study Investigators et al (2018) Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE randomized clinical trial. JAMA 319(7):680–690. https://doi.org/10.1001/jama.2018.0160 CrossRefPubMedPubMedCentral

14.

Rivosecchi RM, Smithburger PL, Svec S, Campbell S, Kane-Gill SL (2015) Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse 35:39–50. https://doi.org/10.4037/ccn2015423 CrossRefPubMed

15.

Collet MO, Caballero J, Sonneville R et al (2018) Prevalence and risk factors related to haloperidol use for delirium in adult intensive care patients: the multinational AID-ICU inception cohort study. Intensive Care Med 44:1081–1089. https://doi.org/10.1007/s00134-018-5204-y CrossRefPubMed

16.

Barr J, Fraser GL, Puntillo K, American College of Critical Care Medicine et al (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1):263–306. https://doi.org/10.1097/CCM.0b013e3182783b72 CrossRefPubMed

17.

Trogrlić Z, van der Jagt M, Bakker J, Balas MC, Ely EW, van der Voort PH, Ista E (2015) A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes. Crit Care 19:157. https://doi.org/10.1186/s13054-015-0886-9 CrossRefPubMedPubMedCentral

18.

Barnes-Daly MA, Phillips G, Ely EW (2017) Improving hospital survival and reducing brain dysfunction at seven california community hospitals: implementing PAD guidelines via the ABCDEF bundle in 6,064 patients. Crit Care Med 45:171–178. https://doi.org/10.1097/CCM.0000000000002149 CrossRefPubMed

19.

Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340(9):669–676. https://doi.org/10.1056/NEJM199903043400901 CrossRefPubMed

20.

Marcantonio ER, Flacker JM, Wright RJ, Resnick NM (2001) Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 49:516–522. https://doi.org/10.1046/j.1532-5415.2001.49108.x CrossRefPubMed

21.

Martinez FT, Tobar C, Beddings CI, Vallejo G, Fuentes P (2012) Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing 41:629–634. https://doi.org/10.1093/ageing/afs060 CrossRefPubMed

22.

Bannon L, McGaughey J, Clarke M, McAuley DF, Blackwood B (2016) Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research. Syst Rev 5:75. https://doi.org/10.1186/s13643-016-0254-0 CrossRefPubMedPubMedCentral

23.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses. The PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

24.

Higgins JPT, Green S (eds) (2011) The Cochrane handbook for systematic reviews of interventions version 5.1.0, updated March 2011. The Cochrane Collaboration. http://www.cochrane-handbook.org. Accessed 29 Oct 2018

25.

Review Manager (RevMan) [Computer program] (2014) Version [Version 5.3]. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration

26.

Wan X, Wenqian W, Liu Jiming L, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135. https://doi.org/10.1186/1471-2288-14-135 CrossRefPubMedPubMedCentral

27.

GRADEpro GDT: GRADEpro Guideline Development Tool [Software] (2015) McMaster University (developed by Evidence Prime, Inc.). http://gradepro.org

28.

Ono H, Taguchi T, Kido Y, Fujino Y, Doki Y (2011) The usefulness of bright light therapy for patients after oesophagectomy. Intensive Crit Care Nurse 27:158–166. https://doi.org/10.1016/j.iccn.2011.03.003 CrossRef

29.

Taguchi T, Yano M, Kido Y (2007) Influence of bright light therapy on postoperative patients: a pilot study. Intensive Crit Care Nurse 23:289–297. https://doi.org/10.1016/j.iccn.2007.04.004 CrossRef

30.

Simons KS, Laheij RJ, van den Boogaard M, Moviat MA, Paling AJ, Polderman FN, Rozendaal FW, Salet GA, van der Hoeven JG, Pickkers P, de Jager CP (2016) Dynamic light application therapy to reduce the incidence and duration of delirium in intensive care patients: a randomised controlled trial. Lancet Respir Med 4(3):194–202. https://doi.org/10.1016/S2213-2600(16)00025-4 CrossRefPubMed

31.

Potharajaroen S, Tangwongchai S, Tayjasanant T, Thawitsri T, Anderson G, Maes M (2018) Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid base balance disturbances. Psychiatry Res 261:21–27. https://doi.org/10.1016/j.psychres.2017.12.046 CrossRefPubMed

32.

Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG (2012) The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 16:R73. https://doi.org/10.1186/cc11330 CrossRefPubMedPubMedCentral

33.

Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882. https://doi.org/10.1016/S0140-6736(09)60658-9 CrossRefPubMed

34.

Álvarez EA, Garrido MA, Tobar EA, Prieto SA, Vergara SO, Briceño CD, González FJ (2017) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: a pilot randomized clinical trial. J Crit Care 37:85–90. https://doi.org/10.1016/j.jcrc.2016.09.002 CrossRefPubMed

35.

Morris PE, Berry MJ, Files DC et al (2016) Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. JAMA 315(24):2694–2702. https://doi.org/10.1001/jama.2016.7201 CrossRefPubMedPubMedCentral

36.

Finotto S, Artioli G, Davoli L, Barbara B (2006) Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomised study. Prof Inferm 59:228–232 (Italian)PubMed

37.

Girard TD, Kress JP, Fuchs BD et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134. https://doi.org/10.1016/S0140-6736(08)60105-1 CrossRefPubMed

38.

Mehta S, Burry L, Cook D, SLEAP Investigators, Canadian Critical Care Trials Group et al (2012) Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomised controlled trial. JAMA 308:1985–1992. https://doi.org/10.1001/jama.2012.13872 CrossRefPubMed

39.

Moon KJ, Lee S-M (2015) The effects of a tailored intensive care unit delirium prevention protocol: a randomised controlled trial. Int J Nurs Stud 52:1423–1432. https://doi.org/10.1016/j.ijnurstu.2015.04.021 CrossRefPubMed

40.

Munro CL, Cairns P, Ji M, Calero K, McDowell Anderson W, Liang Z (2017) Delirium prevention in critically ill adults through an automated reorientation intervention—a pilot randomised controlled trial. Heart Lung 46:234–238. https://doi.org/10.1016/j.hrtlng.2017.05.002 CrossRefPubMed

41.

Giraud K, Pontin M, Sharples LD, Fletcher P, Dalgleish T, Eden A, Jenkins DP, Vuylsteke A (2016) Use of a structured mirrors intervention does not reduce delirium incidence but may improve factual memory encoding in cardiac surgical ICU patients aged over 70 years: a pilot time-cluster randomized controlled trial. Front Aging Neurosci 8:228. https://doi.org/10.3389/fnagi.2016.00228 CrossRefPubMedPubMedCentral

42.

Karadas C, Ozdemir L (2016) The effect of range of motion exercises on delirium prevention among patients aged 65 and over in ICU. Geriatr Nurs 37:180–185. https://doi.org/10.1016/j.gerinurse.2015.12.003 CrossRefPubMed

43.

Rivosecchi R, Smithburger PL, Svec S, Campbell S, Kane-Gill SL (2015) Nonpharmacological interventions to prevent delirium: an evidence based systematic review. Crit Care Nurse 35:39–50. https://doi.org/10.4037/ccn2015423 CrossRefPubMed

44.

Collinsworth AW, Priest EL, Campbell CR, Vasilevskis EE, Masica AL (2016) A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units. J Intensive Care Med 31:127–141. https://doi.org/10.1177/0885066614553925 CrossRefPubMed

45.

Vincent JL, Shehabi Y, Walsh TS et al (2016) Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med 42:962–971. https://doi.org/10.1007/s00134-016-4297-4 CrossRefPubMedPubMedCentral

46.

Rose L, Agar M, Burry LD, Campbell N, Clarke M, Lee J, Siddiqi N, Page VJ, Del-COrS Group (2017) Development of core outcome sets for effectiveness trials of interventions to prevent and/or treat delirium (Del-COrS): study protocol. BMJ Open 7:e016371-2017-016371. https://doi.org/10.1136/bmjopen-2017-01637 CrossRef

47.

Pandharipande PP, Ely EW, Arora RC et al (2017) The intensive care delirium research agenda: a multinational, interprofessional perspective. Intensive Care Med 43:1329–1339. https://doi.org/10.1007/s00134-017-4860-7 CrossRefPubMedPubMedCentral

48.

Hoffmann TC, Glasziou PP, Milne R et al (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687. https://doi.org/10.1136/bmj.g1687 CrossRefPubMed

49.

Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350:h1258. https://doi.org/10.1136/bmj.h1258 CrossRefPubMedPubMedCentral

50.

Bathula M, Gonzales JP (2013) The pharmacologic treatment of intensive care unit delirium: a systematic review. Ann Pharmacother 47(9):1168–1174. https://doi.org/10.1177/1060028013500466 CrossRefPubMed

51.

Liu X, Zhang K, Wang W, Xie G, Cheng B, Wang Y, Hu Y, Fang X (2016) Dexmedetomidine versus propofol sedation improves sublingual microcirculation after cardiac surgery: a randomized controlled trial. J Cardiothorac Vasc Anesth 30(6):1509–1515. https://doi.org/10.1053/j.jvca.2016.05.038 CrossRefPubMed

52.

Poulsen LM, Andersen-Rnaberg NC (2018) Agents intervening against delirium in intensive care unit (AID-ICU). https://clinicaltrials.gov/ct2/show/NCT03392376. Accessed 30 Aug 2018

Titel: The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis
verfasst von: Leona Bannon
Jennifer McGaughey
Rejina Verghis
Mike Clarke
Daniel F. McAuley
Bronagh Blackwood
Publikationsdatum: 30.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 1/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5452-x

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The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis