Effect of Delirium Prevention Program on Delirium Occurrence and the Length of Intensive Care Unit (ICU) Stay: A Systematic Review and Meta-Analysis
Abstract
Background: ICU patients typically experience diverse kinds of distress factors, which make them vulnerable to delirium thereby resulting in a higher rate of delirium occurrence. We aimed to review systematically current states of preventive nursing intervention in ICUs, and to analyze delirium occurrence and the length of ICU stay to provide suggestions for the preventive nursing practice in ICU.
Methods: Data collection was done with literature search databases including PubMed, Ovid-MEDLINE, EMBASE, CINAHL, KMbase, KoreaMed, Korean Studies Information Service System (KISS), Korea Institute of Science and Technology Information (KiSTi), Research Information Service System (RISS) and with hand searching, from Apr 20 to May 10, 2020. Two researchers independently selected research literature, and three researchers summarized and identified related variables based on data extraction methods.
Results: Overall, 236 articles identified, 11 articles met the inclusion criteria for review. The systematic review of the contents of preventive nursing intervention other than drug administration rendered the four types of intervention. The Peto odds ratio (OR) of the rate of delirium occurrence appeared as 0.29 (95% Confidence Interval (CI)=0.20∼0.43) which was statistically significant (Z=6.23, P<.01) in both group. The magnitude of the effect for the length of ICU stay demonstrated insignificant values, Mean difference (MD) –0.23 (95% CI=-0.51∼0.05) (Z=1.60, P=.11).
Conclusion: For management of delirium among ICU patients, multi-component intervention packages, suitable for care setting in ICUs, need to be taken into account for the preparation of nursing intervention for prevention of delirium applicable to nursing practices.
2. Chun YK, Park JY (2017). Risk factors of delirium among the patients at a surgical intensive care unit. J Korean Crit Care Nurs, 10(3), 31-40.
3. Lee HJ, Kim SR (2018). Factors influencing delirium in neurological intensive care unit patient. Korean J Adult Nurs, 30(5), 470-481.
4. Krewulak K, Stelfox H, Leigh J et al (2018). Incidence and prevalence of delirium subtypes in an adult ICU: A systematic review and meta-analysis. Crit Care Med, 46(12), 2029-2035.
5. Mehta S, Cook D, Devlin J et al(2015). Prev-alence, risk factors, and outcomes of de-lirium in mechanically ventilated adults. Crit Care Med, 43(3), 557-566.
6. Kooken RWJ, van den Berg M, Slooter AJC et al (2021). Factors associated with a per-sistent delirium in the intensive care unit: A retrospective cohort study. J Crit Care. 66, 132-137.
7. Witlox J, Eurelings LSM, de Jonghe JFM et al (2010). Delirium in elderly patients and the risk of postdischarge mortality, insti-tutionalization, and dementia: A meta-analysis. JAMA, 304(4), 443–451.
8. Devlin JW, Skrobik Y, Gélinas C et al (2018). Clinical practice guidelines for the prevention and management of pain, agi-tation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 46(9), e825-e873.
9. Barr J, Fraser GL, Puntillo K et al (2013). Clinical practice guidelines for the man-agement of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 41(1), 263-306.
10. Ely EW, Gautam S, Margolin R et al (2001). The impact of delirium in the intensive care unit on hospital length of stay. Inten-sive Care Med, 27(12), 1892-1900.
11. Partridge JS, Martin FC, Harari D et al (2013). The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?. Int J Geriatr Psychiatry, 28(8), 804-812.
12. Kotfis K, Marra A, Ely EW (2018). ICU de-lirium-a diagnostic and therapeutic chal-lenge in the intensive care unit. Anaesthsiol Intensive Ther, 50(2), 128–140.
13. National Institute for Health and Care Ex-cellence (2019). Delirium: prevention, diagnosis and management Clinical guideline (CG103). National Institute for Health and Clinical Excellence Guidance. https://www.nice.org.uk/guidance/cg103
14. Trogrlić Z, van der Jagt M, Bakker J et al (2015). A systematic review of implemen-tation strategies for assessment, preven-tion, and management of ICU delirium and their effect on clinical outcomes. Crit Care, 19(1), 1-17.
15. Barnes-Daly MA, Phillips G, Ely E (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(2), 171-178.
16. Herling SF, Greve IE, Vasilevskis EE et al (2018). Interventions for preventing in-tensive care unit delirium in adults. Cochrane Database Syst Rev, 11(11):CD009783.
17. Bannon L, McGaughey J, Verghis R et al (2019). The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Med, 45(1), 1-12.
18. Kang J, Lee M, Ko H et al (2018). Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: a systematic review and meta-analysis. J Crit Care, 48, 372-384.
19. Neufeld KJ, Joseph Bienvenu O, Rosenberg PB et al (2011). The Johns Hopkins delir-ium consortium: a model for collaborat-ing across disciplines and departments for delirium prevention and treatment. J Am Geriatr Soc, 59, S244-S248.
20. Moher D, Liberati A, Tetzlaff J et al (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. J Clin Epidemiol, 62(10), 1006-1012.
21. Higgins JP, Thomas J, Chandler J et al (2019). Cochrane handbook for systematic re-views of interventions. John Wiley & Sons. https://training.cochrane.org/handbook/current
22. Kim SY, Park DA, Seo HJ et al (2020). Health technology assessment methodology: system-atic review. National Evidence-based Healthcare Collaborating Agency. https://www.neca.re.kr/lay1/bbs/S1T11C102/F/39/view.do?article_seq=8346&cpage=1&rows=10&condition=&keyword=&show=&cat=
23. Kang H (2015). Statistical considerations in meta-analysis. Hanyang Med Rev, 35(1), 23-32.
24. Sterne JA, Sutton AJ, Ioannidis JP et al (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomized controlled trials. Br Med J, 343.
25. Inouye SK, Bogardus Jr ST, Charpentier PA et al (1999). A multicomponent interven-tion to prevent delirium in hospitalized older patients. N Engl J Med, 340(9), 669-676.
26. Flannery AH, Oyler DR, Weinhouse GL (2016). The impact of interventions to improve sleep on delirium in the ICU: a systematic review and research frame-work. Crit Care Med, 44(12), 2231-2240.
27. Wassenaar A, van den Boogaard MHWA, van Achterberg T et al (2015). Multina-tional development and validation of an early prediction model for delirium in ICU patients. Intensive Care Med, 41(6), 1048-1056.
28. Deng LX, Zhang LN, Peng XB (2020). Non-pharmacological interventions to reduce the incidence and duration of de-lirium in critically ill patients: a systematic review and network meta-analysis. J Crit Care, 60, 241-248.
29. Moon KJ, Lee SM (2010). Development of an evidence-based protocol for prevent-ing delirium in intensive care unit patients. J Korean Clin Nurs Res, 16(3), 175-186.
| Files | ||
| Issue | Vol 51 No 8 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i8.10256 | |
| Keywords | ||
| Delirium Intensive care unit Systematic review Meta-analysis | ||
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