Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Aust Crit Care. 2017 Nov;30(6):321-327. doi: 10.1016/j.aucc.2016.12.004. Epub 2017 Jan 10.
Delirium is common in Intensive Care Unit (ICU) patients and associated with poor outcome. In non-ICU patients a multicomponent intervention program with non-pharmacological interventions has shown to reduce delirium. Currently, there is insufficient evidence regarding the effects of such a program in ICU patients. We developed a draft program based on a review. As most studies were conducted in non-ICU patients, the feasibility of the program in ICU patients needs to be assessed before investigating its effectiveness.
To determine experts' opinion and to achieve group consensus on the feasibility and completeness of the multicomponent intervention program for ICU patients.
A modified RAND/UCLA Appropriateness Method Delphi study was used. A total of 38 experts were selected following purposive sampling. Round one informed the experts about the draft program and asked for their opinion about its feasibility and completeness. In round two the experts were asked to reconsider their opinion based on changes made, and to rank the interventions in order of importance. The feasibility was scored using a 9-point Likert scale. A disagreement index (DI) and panel median were calculated to determine the level of agreement.
During Delphi round one 100% of the questionnaires was completed, during round two 79%. After two rounds the experts agreed on the feasibility of the interventions targeting sleep deprivation (panel median 7.00, DI 0.26), immobility (panel median 8.00, DI 0.22), visual and hearing impairment (panel median 8.00, DI 0.19), and cognitive impairment (panel median 8.00, DI 0.23), except for cognitive training (panel median 5.00, DI 0.52).
During this study a feasible multicomponent intervention program to prevent ICU delirium was developed based on expert consensus. As no consensus was reached on cognitive training, a pilot study is planned to determine the feasibility of cognitive training in the ICU.
谵妄在重症监护病房（ICU）患者中很常见，且与不良预后相关。在非 ICU 患者中，多组分干预方案联合非药物干预已被证明可减少谵妄。目前，关于该方案在 ICU 患者中的效果的证据不足。我们基于文献回顾制定了一个草案方案。由于大多数研究都是在非 ICU 患者中进行的，因此在研究其有效性之前，需要评估该方案在 ICU 患者中的可行性。
确定专家对 ICU 患者多组分干预方案的可行性和完整性的意见，并达成小组共识。
采用改良的 RAND/UCLA 适宜性方法德尔菲研究。通过目的性抽样选择了 38 名专家。第一轮告知专家草案方案，并征求他们对其可行性和完整性的意见。在第二轮中，专家被要求根据修改后的方案重新考虑他们的意见，并按重要性对干预措施进行排序。使用 9 分李克特量表对可行性进行评分。计算分歧指数（DI）和小组中位数以确定一致性水平。
在德尔菲研究第一轮中，100%的问卷完成，第二轮中为 79%。两轮后，专家们一致认为针对睡眠剥夺（小组中位数 7.00，DI 0.26）、活动受限（小组中位数 8.00，DI 0.22）、视力和听力障碍（小组中位数 8.00，DI 0.19）和认知障碍（小组中位数 8.00，DI 0.23）的干预措施具有可行性，但认知训练除外（小组中位数 5.00，DI 0.52）。
在这项研究中，基于专家共识制定了一个可行的多组分干预方案来预防 ICU 谵妄。由于对认知训练没有达成共识，计划进行一项试点研究以确定 ICU 中认知训练的可行性。
