Nursing intervention to prevent delirium in critically ill adults

Abstract

Objective: To determine the effectiveness of a nursing intervention for delirium prevention in critically ill patients. Method: A quasi-experimental study was conducted with a non-equivalent control group and with evaluation before and after the intervention. 157 Patients were part of the intervention group and 134 of the control group. Patients were followed-up until they were discharged from the ICU or died. The incidence of delirium in both groups was compared. Additionally, the effect measures were adjusted for the propensity score. Results: The incidence and incidence rate of delirium in the control group were 20.1% and 33.1 per 1000 person-days (CI 95% 22.7 to 48.3) and in the intervention group was 0.6% and 0.64 per 1000 person-days (CI 95% 0.22 to 11.09), respectively. The crude Hazard Ratio was 0.06 (CI 95% 0,008 to 0,45) and adjusted 0.07 (CI 95% 0,009 to 0,60). The number needed to be treated was six. Conclusion: Low incidence of delirium in critically ill patients intervened demonstrated the effectiveness of interventions. The average intervention time was 4 days with a 15-minutes dedication for each patient.

Delirium management in critically ill patients: an integrative review

“…3,32,36,38,46 Within the scope of non-pharmacological interventions, early mobilization/rehabilitation, family engagement, management of environmental factors aiming to promote sleep, frequent reorientation and cognitive stimulation were identified. 3,33,[35][36][37]39,46,47,50 Age is the most important predisposing risk factor for delirium, that leads to agerelated changes in cerebral blood flow, metabolic rate, neurochemical activity, conducting to brain vulnerability with less ability to handle stress factors, and with a high incidence of multimorbidity. 1,3,5,46 As such, interventions that target cognitive stimulation, adapted to person's preferences in older complex patients are crucial.…”

“…1,3,5,46 As such, interventions that target cognitive stimulation, adapted to person's preferences in older complex patients are crucial. 33,47 Single component interventions related with early mobility/rehabilitation and family engagement, stand out with better outcomes in caring for the critically ill patient with delirium. 34,36,40,43,47 Family engagement emerges like a promising intervention, with positive results in delirium incidence and duration, but also at psychological recovery and satisfaction of the person and family with the care provided.…”

“…3,36,39,46 3.3 NON-PHARMACOLOGICAL INTERVENTIONS: SINGLE COMPONENT Among the non-pharmacological single component interventions, early mobilization/rehabilitation and family engagement stand out as the most relevant interventions in critically ill patients with delirium. 33,35,39,42,46 Early mobilization/rehabilitation emerges as a safe and well tolerated intervention in the critically ill, even those under mechanical ventilation. 3,36,39,46 Physical restraints and medical devices in these patients are factors that potentiate delirium development, contributing to immobility, and should be removed as soon as possible.…”

“…35,39,42,46 Family engagement is a promising intervention to reduce delirium incidence and duration in critically ill patients, but further research is needed. 33,35,36,42,45,46 This also represents benefits regarding psychological recovery of patients and their families, stress reduction, as well as satisfaction with care. 36,42 Family presence also facilitates interventions, such as cognitive reorientation, which is more efficient when carried out in a familiar voice, leading to less days with delirium, disclosing the importance of person-centred care.…”

“…34,45 Single component intervention focused on reorientation (e.g., visible clocks and calendars) and cognitive stimulation, including vision and hearing, show effectiveness in reducing confusion 42 and decreasing delirium incidence. 33,36,39,46 The importance of correcting existing visual and hearing impairments, by providing glasses and hearing aids, is emphasized. [36][37][38]42,48 A systematic review on cognitive interventions reported that it was not possible to conclude and support clearly the use of cognitive interventions in delirium outcomes.…”