Non-pharmacological interventions to prevent delirium in hospitalized non-ICU patients.
Burton JK, Craig LE, Yong SQ, Siddiqi N, Teale EA, Woodhouse R, Barugh AJ, Shepherd AM, Brunton A, Freeman SC, Sutton AJ, Quinn TJ Non-pharmacologic interventions to prevent delirium in hospitalized non-ICU patients. pharmacological interventions. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013307. doi: 10.1002 /14651858.CD013307.pub2. Accessed July 29, 2021.
Commentary
This study was conducted to evaluate the efficacy of a non-pharmacological intervention designed to prevent delirium in hospitalized patients outside the intensive care unit (ICU).
The main results reviewed included 22 RCTs that recruited a total of 5718 adult participants, and 14 trials compared multicomponent delirium prevention interventions with usual care.
Two trials compared thresholds for liberal versus restrictive transfusions, and the remaining six trials investigated different non-pharmacological interventions.
The incidence of delirium was reported in all studies.
The Cochrane Risk of Bias tool was used to identify the risk of bias in all included trials. All were at high risk of performance bias because the participants and personnel were not informed of the intervention. In addition, nine trials were at high risk of detection bias because they were not blinded to outcome assessors, and three trials had unclear risk in this area.
These pooled data suggest that multicomponent, non-pharmacological interventions may reduce the incidence of delirium compared to usual care.
Compared to usual care, there may be no effect of the multicomponent intervention on inpatient mortality at all.
Studies of multicomponent interventions did not report data on new diagnoses of dementia.
There are reports that multicomponent interventions may reduce the duration of delirium episodes by about one day. The evidence for the effect of multicomponent interventions on the severity of delirium is very uncertain, according to the authors.
They say that multicomponent interventions may also result in shorter hospital stays compared to usual care, with no difference at all in admission to a new care home at discharge. Reports of other adverse outcomes were limited.
A meta-analysis of exploratory component networks found that reorientation, cognitive stimulation, and sleep hygiene were associated with a lower risk of developing delirium.
Nutrition and hydration, oxygenation, medication review, mood and bowel assessment, and attention to bladder care may be associated with a reduction in the incidence of delirium, while reduced sensory deprivation, infection identification, mobilization, and pain management all have summary estimates suggesting a potential increase in the incidence of delirium.
Evidence from two trials suggested that the use of a generous transfusion threshold above the restrictive transfusion threshold made no difference at all in incident delirium.
Six other interventions were reviewed, but the evidence for each was limited to a single study, and no evidence for delirium prevention was identified.
The authors concluded that
There is evidence of moderate certainty regarding the benefits of multicomponent, nonpharmacologic interventions for the prevention of delirium in hospitalized adults, with an estimated 43% reduction in incidence compared with usual care. No evidence of an effect on mortality was found. The impact on the severity of delirium remains uncertain, but there is emerging evidence that these interventions tend to shorten hospital stays and reduce the duration of delirium. Further research should focus on the implementation and in-depth analysis of the components of the interventions to support recommendations for more effective and coordinated practices.
