Mobilization in the evening reduces delirium in critically ill patients: the MENTAL randomized, controlled trial

Abstract

Background : Delirium is a common complication in patients on Intensive Care Units (ICU). Caring interventions such as early mobilization are effective in prevention and treatment of delirium, but are recommended during daytime. It may be effective in the night, too. Method : The aim of this study was to prove the effect of mobilization in the evening to prevent or treat ICU patients from delirium. The design was a multicentric, randomized, controlled trial in 5 mixed ICUs over a period of 2 weeks with max. 28 days follow-up. Patients in the intervention group were mobilized onto the edge of the bed or more between 9:00 and 11:00 p.m. by an additional mobilization team, following safety criteria. Patients in the control group received usual care. Primary outcome parameter was the duration of a delirium. Secondary parameters were presence of delirium, mortality, duration of mechanical ventilation (MV) and stay, feasibility, and mobilization-related complications. Results : In summary, n=69 patients could be analysed (intervention n=36, control n=33). Due to limited resources, the trial was stopped and reached 62% of targeted sample size. Mobilization in the evening did not significantly reduce duration of existing delirium, delirium presence, length of MV or days in ICU and hospital for 28 days follow-up. In an unplanned post-hoc analysis, mobilization in the evening prevented patients from delirium in the first four days (6 (16.7%) vs. 13 (39.4%), p=0.032), with a number needed to treat of 5. The intervention was feasible in 71.7% of eligible patients, with 13.6% unwanted safety events. Conclusions : In a mixed ICU population, mobilization in the evening did not show a reduction in duration of delirium, MV or length of stay, but a reduction in the incidence of early onset delirium. Mobilization between 9:00 and 11:00 pm. by an interprofessional mobilization team may prevent patients from delirium. The intervention was feasible, safe, and accepted by most patients.

Investigating the impact of physical activity interventions on delirium outcomes in intensive care unit patients: A systematic review and meta-analysis

“…One further study was included after reference screening. The 12 included studies (Table 1) comprised of 10 RCTs 20,22,23,[32][33][34][35][36][37][38] one observational casematched control 39 and one before-after quality improvement study 21 . The two reviewers reached consensus regarding study inclusion, data extraction, quality, and ROB assessments (100% agreement), without recourse to a third reviewer.…”

“…One study had an age requirement of 65 years and above 33 . All other studies included participants over 18 years with varying intervention start times from minimum of 24 hours 33,37 to maximum 96 hours post admission 22 (Supplementary material). 3), most commonly delivered as a progressive early mobility protocol [20][21][22][35][36][37]39 .…”

“…All other studies included participants over 18 years with varying intervention start times from minimum of 24 hours 33,37 to maximum 96 hours post admission 22 (Supplementary material). 3), most commonly delivered as a progressive early mobility protocol [20][21][22][35][36][37]39 . Two studies investigated range of movement (ROM) exercises 21,37 , two studies used in-bed cycling 22,39 and two used functional electrical stimulation (FES)-cycling 32,38 .…”

“…Most of the studies [20][21][22][32][33][34][36][37][38][39] used CAM-ICU to measure delirium (Table 1). One study 23 used the ICDSC, and one multi-centre study utilised both tools 35 .…”

“…Figure 2 presents the included RCTs ROB2 assessments. Five studies were judged to be at high ROB either through having high risk in one domain or some concerns in multiple domains 23,[33][34][35]37 .…”