The Nethersole School of Nursing, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
Aust Crit Care. 2021 Jul;34(4):378-387. doi: 10.1016/j.aucc.2020.10.004. Epub 2020 Nov 26.
Delirium is common in critically ill patients and may lead to severe complications, such as falls and injuries. Nonpharmacological interventions have been widely suggested to prevent delirium, yet the effects remain uncertain.
The aim of the study was to determine the effects of nonpharmacological interventions on preventing delirium and improving critically ill patients' clinical, psychological, and family outcomes.
Ten databases were searched from their inception to September 2020. Two reviewers assessed the methodological quality and extracted details of the included studies. The data were narratively or statistically pooled where appropriate. Dichotomous variables are presented as odds ratio (OR), and continuous variables are presented as mean difference (MD). The Grading of Recommendations Assessment, Development, and Evaluation criteria were used to assess the quality of evidence for each review outcome.
Thirty-four studies (10 randomised controlled trials, eight controlled clinical trials, and 16 before-and-after studies) were included in the analysis. Low-certainty evidence indicated that nonpharmacological interventions reduced delirium incidence (OR = 0.43, 95% confidence interval [CI] [0.33, 0.55]), delirium duration (MD = -1.43 days, 95% CI [-1.94, 0.92]), and length of stay in the intensive care unit (MD = -1.24 days, 95% CI [-2.05, -0.43]). Moderate-certainty evidence demonstrated no effect on mortality. Narrative synthesis further implied improvements in patients' psychological recovery (two studies, very low-certainty evidence) and families' satisfaction with care (two studies, very low-certainty evidence) through nonpharmacological interventions. As for effective intervention types, moderate-certainty evidence demonstrates that early mobilisation (OR = 0.33, 95% CI [0.24, 0.46], five studies, 859 participants, I = 24%), family participation (OR = 0.25, 95% CI [0.18, 0.34], four studies, 997 participants, I = 21%), and use of multicomponent interventions (OR = 0.48, 95% CI [0.34, 0.69], 13 studies, 3172 participants, I = 77%) are associated with reduced incidence of delirium.
Healthcare professionals are recommended to apply early mobilisation, family participation, or multicomponent interventions in clinical practice to prevent delirium. Further studies investigating the effects of nonpharmacological interventions on patients' psychological and family outcomes are warranted.
谵妄在危重症患者中很常见，可能导致严重并发症，如跌倒和受伤。已经广泛建议使用非药物干预措施来预防谵妄，但效果仍不确定。
本研究旨在确定非药物干预措施对预防谵妄以及改善危重症患者临床、心理和家庭结局的效果。
从成立到 2020 年 9 月，对 10 个数据库进行了搜索。两位评审员评估了纳入研究的方法学质量并提取了研究细节。在适当的情况下，以叙述或统计学方式汇总数据。二项变量表示为优势比（OR），连续变量表示为均数差（MD）。使用推荐评估、制定和评估标准（Grading of Recommendations Assessment, Development, and Evaluation criteria）评估每个综述结果的证据质量。
分析纳入了 34 项研究（10 项随机对照试验、8 项对照临床试验和 16 项前后对照研究）。低确定性证据表明，非药物干预措施降低了谵妄发生率（OR=0.43，95%置信区间[CI] [0.33, 0.55]）、谵妄持续时间（MD=-1.43 天，95%CI [-1.94, 0.92]）和重症监护病房住院时间（MD=-1.24 天，95%CI [-2.05, -0.43]）。中等确定性证据表明，非药物干预措施对死亡率没有影响。叙述性综合进一步表明，非药物干预措施改善了患者的心理康复（两项研究，极低确定性证据）和家庭对护理的满意度（两项研究，极低确定性证据）。至于有效的干预类型，中等确定性证据表明，早期活动（OR=0.33，95%CI [0.24, 0.46]，五项研究，859 名参与者，I²=24%）、家庭参与（OR=0.25，95%CI [0.18, 0.34]，四项研究，997 名参与者，I²=21%）和使用多组分干预（OR=0.48，95%CI [0.34, 0.69]，13 项研究，3172 名参与者，I²=77%）与降低谵妄发生率相关。
建议临床医生在实践中应用早期活动、家庭参与或多组分干预措施来预防谵妄。还需要进一步研究非药物干预措施对患者心理和家庭结局的影响。
