The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved]
Background: Post-operative delirium is a common complication among adult patients in the intensive care unit. Current literature does not support the use of pharmacologic measures to manage this condition, and several studies explore the potential for the use of non-pharmacologic methods such as ear...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2022-06-01
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| Online Access: | https://f1000research.com/articles/9-1178/v3 |
| _version_ | 1797996498316689408 |
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| author | Julie S Cupka Ria Bhaskar Haleh Hashemighouchani Parisa Rashidi Tezcan Ozrazgat-Baslanti Azra Bihorac Matthew M. Ruppert Jessica Lipori |
| author_facet | Julie S Cupka Ria Bhaskar Haleh Hashemighouchani Parisa Rashidi Tezcan Ozrazgat-Baslanti Azra Bihorac Matthew M. Ruppert Jessica Lipori |
| author_sort | Julie S Cupka |
| collection | DOAJ |
| description | Background: Post-operative delirium is a common complication among adult patients in the intensive care unit. Current literature does not support the use of pharmacologic measures to manage this condition, and several studies explore the potential for the use of non-pharmacologic methods such as early mobility plans or environmental modifications. The aim of this systematic review is to examine and report on recently available literature evaluating the relationship between non-pharmacologic management strategies and the reduction of delirium in the intensive care unit. Methods: Six major research databases were systematically searched for articles analyzing the efficacy of non-pharmacologic delirium interventions in the past five years. Search results were restricted to adult human patients aged 18 years or older in the intensive care unit setting, excluding terminally ill subjects and withdrawal-related delirium. Following title, abstract, and full text review, 27 articles fulfilled the inclusion criteria and are included in this report. Results: The 27 reviewed articles consist of 12 interventions with a single-component investigational approach, and 15 with multi-component bundled protocols. Delirium incidence was the most commonly assessed outcome followed by duration. Family visitation was the most effective individual intervention while mobility interventions were the least effective. Two of the three family studies significantly reduced delirium incidence, while one in five mobility studies did the same. Multi-component bundle approaches were the most effective of all; of the reviewed studies, eight of 11 bundles significantly improved delirium incidence and seven of eight bundles decreased the duration of delirium. Conclusions: Multi-component, bundled interventions were more effective at managing intensive care unit delirium than those utilizing an approach with a single interventional element. Although better management of this condition suggests a decrease in resource burden and improvement in patient outcomes, comparative research should be performed to identify the importance of specific bundle elements. |
| first_indexed | 2024-04-11T10:18:22Z |
| format | Article |
| id | doaj.art-8c909edf3efb45b4abf4e6761295fe46 |
| institution | Directory Open Access Journal |
| issn | 2046-1402 |
| language | English |
| last_indexed | 2024-04-11T10:18:22Z |
| publishDate | 2022-06-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | F1000Research |
| spelling | doaj.art-8c909edf3efb45b4abf4e6761295fe462022-12-22T04:29:51ZengF1000 Research LtdF1000Research2046-14022022-06-019134761The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved]Julie S Cupka0Ria Bhaskar1Haleh Hashemighouchani2https://orcid.org/0000-0002-1995-5072Parisa Rashidi3https://orcid.org/0000-0003-4530-2048Tezcan Ozrazgat-Baslanti4Azra Bihorac5https://orcid.org/0000-0002-5745-2863Matthew M. Ruppert6Jessica Lipori7Department of Medicine, University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USAIntelligent Critical Care Center (IC3), University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USADepartment of Medicine, University of Florida, Gainesville, FL, 32608, USABackground: Post-operative delirium is a common complication among adult patients in the intensive care unit. Current literature does not support the use of pharmacologic measures to manage this condition, and several studies explore the potential for the use of non-pharmacologic methods such as early mobility plans or environmental modifications. The aim of this systematic review is to examine and report on recently available literature evaluating the relationship between non-pharmacologic management strategies and the reduction of delirium in the intensive care unit. Methods: Six major research databases were systematically searched for articles analyzing the efficacy of non-pharmacologic delirium interventions in the past five years. Search results were restricted to adult human patients aged 18 years or older in the intensive care unit setting, excluding terminally ill subjects and withdrawal-related delirium. Following title, abstract, and full text review, 27 articles fulfilled the inclusion criteria and are included in this report. Results: The 27 reviewed articles consist of 12 interventions with a single-component investigational approach, and 15 with multi-component bundled protocols. Delirium incidence was the most commonly assessed outcome followed by duration. Family visitation was the most effective individual intervention while mobility interventions were the least effective. Two of the three family studies significantly reduced delirium incidence, while one in five mobility studies did the same. Multi-component bundle approaches were the most effective of all; of the reviewed studies, eight of 11 bundles significantly improved delirium incidence and seven of eight bundles decreased the duration of delirium. Conclusions: Multi-component, bundled interventions were more effective at managing intensive care unit delirium than those utilizing an approach with a single interventional element. Although better management of this condition suggests a decrease in resource burden and improvement in patient outcomes, comparative research should be performed to identify the importance of specific bundle elements.https://f1000research.com/articles/9-1178/v3critical care delirium intensive care non-pharmacologic systematic revieweng |
| spellingShingle | Julie S Cupka Ria Bhaskar Haleh Hashemighouchani Parisa Rashidi Tezcan Ozrazgat-Baslanti Azra Bihorac Matthew M. Ruppert Jessica Lipori The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] F1000Research critical care delirium intensive care non-pharmacologic systematic review eng |
| title | The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] |
| title_full | The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] |
| title_fullStr | The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] |
| title_full_unstemmed | The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] |
| title_short | The effect of non-pharmacologic strategies on prevention or management of intensive care unit delirium: a systematic review [version 3; peer review: 2 approved] |
| title_sort | effect of non pharmacologic strategies on prevention or management of intensive care unit delirium a systematic review version 3 peer review 2 approved |
| topic | critical care delirium intensive care non-pharmacologic systematic review eng |
| url | https://f1000research.com/articles/9-1178/v3 |
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