Akpinar, 2022

Type of study:

RCT

Setting and country: coronary intensive

care unit (CICU) of a university hospital,

Turkey

Funding and conflicts of interest:

“This study did not receive any specific grant from

funding agencies in the public, commercial, or not-for-profit sectors.

CONFLICT OF INTEREST

The author declare no potential conflicts of interest with respect to

the authorship and/or publication of this article.”

Inclusion criteria:

• 18 years of age and older
•  not having received any sedative medications or opioids for the past 24 hours;
• not having received any general anaesthesia for the previous 24 hours;
• not being mechanically ventilated;
• not suffering from any auditory/ visual problems or any conditions making verbal communication difficult;
• absence of pain;
• being healthy enough to independently insert and remove the earplugs besides wearing an eye mask and taking it off when necessary;
• absence of a previously diagnosed sleep disorder;
• having sufficient cognitive acumen to provide informed consent (GCS > =13 and ICDSC ≤4) at the beginning of the study

Exclusion criteria:

• being under 18 years of age,
• patients whose condition suddenly deteriorated,
• those who could not effectively use earplugs and eye masks during the night
• those who voluntarily withdrawn from the study,
• those who were transferred from the intensive care unit to another department

N total at baseline: 84

Intervention: 42

Control:42

Important prognostic factors²:

For example

age ± SD:

I: 64.04 ± 8.64

C:63.73 ± 6.92

Sex, n %:

I: 24; 57.1% M

C: 22; 52.4% M

Groups comparable at baseline? yes

earplugs and an eye mask

The patients in the experimental group were asked to use earplugs and an eye mask overnight (from approximately 22:30 to 6:30 the next morning) on the second (Time 1) and third nights (Time 2). They were told that the earplugs and eye mask should be

removed only for a short time if an intervention or communication was necessary.

Standard of care

The patients in the control group received only routine care.

Length of follow-up:

3 days

Loss-to-follow-up & Incomplete outcome data:

Intervention: 0

Control: 0

Delirium (critical)

ICDSC

Baseline

I: 0.47 ± 0.50 (43.50)

C: 0.42 ± 0.50 (41.50)

840.000 0.663

Time 1 (second night)

I: 0.33 ± 065 (39.52)

C: 0.50 ± 0.70 (45.48)

Time 2 (third night)

I: 0.19 ± 039 (36.12)

C: 0.57 ± 0.66 (48.88)

Duration of ICU stay (important)

Not reported

Quality of life (important)

Not reported

Mortality

Not reported

Adverse events

Not reported

Note: Unclear what was meant with: “To ensure that all the patients were equally affected by the environmental conditions

that were likely to affect sleep quality in the ICU, such as noise, light, and heat, the same number of patients was included in the

experimental and control groups each night.”

Faustino, 2022

Type of study:

RCT; randomized, controlled, parallel, and open clinical trial

Setting and country:

3 ICUs of a large teaching hospital in Salvador, Brazil from February to September 2019; Brazil

Funding and conflicts of interest:

“This study was funded by the Institutional Scientific Initiation Program

(PICIN) of the University of the State of Bahia (Edital n° 026/

2018), which provided grants for nursing students who participated in

data collection. There was no involvement of the funding source in the

study design, collection, analysis, and interpretation of results, or in

writing this paper and the decision to submit it for publication.”

“The authors declare that they have no competing interests.”

Inclusion criteria:

• expected length of ICU stay was >48 h,
• with the Early Prediction Model for Delirium

in ICU Patients (E-PRE-DELIRIC) score [15] ≥ 10%. (risk of developing delirium into four categories: very low (0–10%), low

(10–20%), moderate (20–35%), and high risk (> 35%))

Exclusion criteria:

• admitted in a state of delirium,
• with receptive aphasia,
• severe hearing and/or visual disturbances preventing adequate communication,
• advanced cognitive impairment, and/or a score on the Richmond Agitation Sedation Scale (RASS) ≤ −4 for over 24 h after initial screening evaluation

N total at baseline:

Intervention: 72

Control: 72

Important prognostic factors2:

age median (IQR)

I: 68.5

(62.0–78.0)

C: 64.5

(57.0–75.5)

Sex, F:

I: 36 (50.0%) F

C: 41 (56.9%) F

“Patients' baseline characteristics were similar across groups, except

for the percentage of clinical admission that was higher in the control group (97.2% versus 83.3%) and the percentage of arterial hyper-tension (59.7% versus 76.4%) that was higher in the intervention group.

bundle of 5 non-pharmacological interventions

The application started within 24 h of ICU admission, after randomization, and applied daily until ICU discharge.

Periodic reorientation:

Twice a day, the research team helped patients orient themselves to the ICU environment, the multidisciplinary team, and the evolution of their clinical condition. In addition, patients were asked about their lives, work, family, leisure activities, and recent issues to stimulate thinking, awareness of their identities, and short- and long-term memories. Photos, personal items, and a radio were requested from the family and kept in the ICU to help with reorientation.)

• cognitive stimulation:

The research team performed seven different cognitive training activities throughout the ICU stay + A folder that was comprised of magazines, word search activities, crossword and Sudoku puzzles, calculus, and painting, was distributed.

• correction of sensory deficits [visual or hearing impairment]:

The research team asked families for glasses and/or hearing aids for those patients who previously used them.,

• environmental

management:

This intervention consisted of installing a calendar and a clock in a place that was easy for patients to see.

• sleep promotion:

In order to promote sleep, the research team distributed eye masks and earplugs. They also requested the ICU staff to avoid the period from 10:00 pm to 6:00 am for scheduling elective procedures and administration of oral, subcutaneous, and intramuscular medications; however, the assistance team was responsible for patient compliance.

Standard of care

Length of follow-up:

Intervention until discharge; outcomes reported until 90 days (mortality)

Loss-to-follow-up & incomplete outcome data:

Intervention: 8/80 (10%)

Reasons (discharge in less than 24 hours of inclusion 4x, death within 24 hours of inclusion 2x; respiratory precaution initiated, 2x))

Control: 8/80 (10%)

Reasons (discharge in less than 24 hours of inclusion 5x; respiratory precaution initiated, 3x))

Incidence of delirium

incidence density of delirium, which is the ratio of patients in delirium to the number of person-days of exposure;

The density of incidence

I: 1.34 × 10−2

C: 2.29 × 10−2 person-days),

aHR, 0.40; 95% CI, 0.17–0.95; p = 0.04; adjusted for Simplified Acute Physiology Score III, surgical admission and alcoholism.

Cumulative incidence

C: 22.2% (n = 16)

I: 12.5% (n = 9)

aRR, 0.44; 95% CI,

0.21–0.91; p = 0.03), adjusting for the same confounders

Delirium, cases

I: 9

C: 16

More specifically:

hypoactive delirium

I: 7

C: 7

Mixed

I: 1

C: 9

Hyperactive

I: 1

C: 0

Delirium duration

I: median 2 (IQR 1–3) days C: median 2 (IQR 1–7.5) days

Duration of ICU stay,

median (IQR), days

I: 4 (3–7.5)

C: 5 (3–7)

Quality of life

Not reported

Mortality

ICU mortality, n (%)

I: 6 (8.3)

C: 9 (12.5)

Adverse events

Not reported

Delirium was defined as a positive episode detected by the Confusion Assessment

Method for the Intensive Care Unit Flowsheet

Kasapoglu, 2022

Type of study:

RCT

Setting and country:

Single centra; ICUs (general ICU and pulmonary ICU) of a state hospital in Turkey

Funding and conflicts of interest:

“This research did not receive any specific grant from funding agencies in the public, commercial of not-for-profit sectors.

Th authors report no actual or potential conflict of interest.”

Inclusion criteria:

• 18 years old
• Being in the first 24h of ICU hospitalization
• RASS score between -1 and +1
• Negative CAM-ICU scale score

Exclusion criteria:

• Age <18y
• Positive CAM-ICU scale score
• Psychiatric illness
• Profound hearling loss
• RASS score out of range of -1 and +1

N total at baseline:

Intervention: 39+34

Control: 34

Analyzed:

I: 30+31

C: 33

Important prognostic factors:

Age, %

56-65y

I-1: 20.5 | I-2: 0

C:  11.8

66-75y

I-1: 38.5 | I-2: 26.5

C:  11.8

76-85y

I-1: 28.2 | I-2: 47.2

C:  44.1

Sex, M%:

I-1: 59% |I-2: 64.7%

C:  41.2%

Mechanically ventilated:

I-1: 5.1% | I-2: 14.7%

C: 2.9%

Groups comparable at baseline?

Age, gender, % ventilated and number of days in ICU differs

Multicomponent intervention

I1:

• orientation strategies: playing audio recordings of a non-family member
• reading a daily newspaper,
• wearing an eye patch at night

I2:

• orientation strategies: playing audio recordings of a family member
• reading a daily newspaper,
• wearing an eye patch at night

Standard of care

Length of follow-up:

3 days

Loss-to-follow-up & incomplete outcome data:

Intervention-1:

N (%) 9/39 (23%)

Reasons (2 x died, 7x transferred)

Intervention-2:

N (%) 3/34 (9%)

Reasons (1 x died, 2x transferred)

Control:

N (%) 1/34 (3%)

Reasons (1 x died)

Incidence of delirium

CAM-ICU

After 3 days of intervention

Negative

I-1+2: 25+29 (88.4%)

C: 24 (72.7%)

Positive

I-1+2: 5+2 (11.6%)

C: 9 (27.3%)

Duration of ICU stay,

Not reported

Quality of life,

Not reported

Mortality

Not reported

Adverse events

Not reported

Rood, 2021

NCT03002701

Type of study:

RCT; Cluster-randomized

Setting and country: Multi center (ICUs of 10 centers: 1 university hospital, 4

Teaching hospitals, and 5 nonteaching

hospitals); the Netherlands

Funding and conflicts of interest: funding and interest specified in publication

Inclusion criteria:

• Medical, surgical, and trauma critically ill patients
• aged >18 years
• at high risk of developing delirium (defined as an Early Prediction of Delirium in ICU Patients [E-PRE-DELIRIC] score of >35%) (17)
• delirium free at time of ICU admission

Exclusion criteria:

• expected ICU stay < 1 day
• if the ICU team determined that reliable assessment for delirium was not possible (because of acute brain injury, audiovisual disorders, language problems, mental disability, aphasia, or sustained coma during complete ICU stay, defined as a Richmond Agitation Sedation Score [RASS] of 23 or lower) (18).

N total at baseline:

Intervention: 924

Control: 825

Important prognostic factors²:

For example

Age, y, mean (SD)

I: 71 (10)

C: 71 (11)

Sex, M/F, n (%)

I: 539/385 (58/42)

C: 508/317 (62/38)

Mechanically ventilated

I: 770 (90%)

C: 685 (86%)

RASS at admission, median (IQR)

I: 23 (25 to 0)

C: 23 (24 to 0)

Groups comparable at baseline? Yes

Multicomponent

nursing intervention program

Optimizing:

Visual and hearing impairment

• Register visual and/or hearing disorders
• and aids
• Encourage the use of (clean) aids.
• Approach the patient from best visual side
• Provide supporting aids when necessary.
• Avoid corneal dehydration during sedation.
• For severely visually impaired: describe actions and environment.
• Make sure patients use their hearing aids. Before use, make sure that the hearing aid is working optimally
• Provide a clean ear canal during daily care.
• Speak clearly and limit ambient noise
• Approach the patient from the best hearing side
• Use available communication techniques

Orientation loss,

• Use the white board
• Frequently orient the patient (clock and daylight).
• Explain daily: location, illness, and progress
• Explain who you are and what you will be doing
• Ensure continuity of care
• Ask for things from home
• Facilitate visits and involve visitors.
• Use a “get to know me poster”

Sleep deprivation,

• Provide plenty of light during the day and limit

light at night.

• Limit actions during sleep
• Limit noise; offer earplugs.
• Offer relaxing music
• Ask about rituals at home.
• Be cautious with sleeping medication.
• Offer a clear day structure.
• Minimize sedation: Aim RASS –2 to +1.

Cognitive impairment,

When RASS –2 to +1:

• Offer 5 minutes of cognitive training 2× daily to prevent/limit deterioration.
• The aim is to stimulate cognition, not to achieve
• correct answers
• Provide optimal posture and timing.

Immobility

• Set (realistic) goals
• Minimize sedation.
• Limit pain and fear.
• Mobilize at least daily.
• Encourage active participation
• If coma (RASS –3/–4/–5): Move passively and frequently change position
• When awake (RASS –2 to +1): Active exercises
• Optimize location of necessary lines/catheters
• Collaborate with involved disciplines.

Nurses were allowed to—based on their professional expertise—individually

tailor the program to patient needs while covering all UNDERPIN-ICU domains as much as possible, starting within 24 hours after ICU admission until ICU discharge.

Standard of care

Length of follow-up:

90 days

Loss-to-follow-up &

Incomplete outcome data:

ITT protocol

Intervention: 0

Control: 0

Per protocol

Intervention: 166+52

Reasons: comatose during admission; including during training period

Control: 134+29

Reasons: comatose during admission; including during training period

Incidence of delirium

(defined as the new onset of delirium [positive CAM-ICU or treatment with haloperidol] after ICU admission),

Delirium incidence

I: 361 (39)

C: 327 (40)

OR 1.10, 95% CI 0.79 to 1.53 p=0.59

Delirium duration

I: median 2 (IQR 1–4) days

C: 2 (IQR 1–4) days

Duration of ICU stay,

Median (IQR)

ICU length of stay

I: 6 (3–12)

C: 6 (3–11)

1.09, 95% CI 0.94 to 1.26

P=0.27

Quality of life

Not reported

Mortality

28-d mortality

I: 297 (32)

C: 273 (33)

1.16† 0.85 to 1.59

P=0.34

90-d mortality

I: 350 (38)

C: 312 (38)

1.24† 0.92 to 1.67

P=0.17

Adverse events

Not reported

Wang, 2022

Type of study:

RCT

Setting and country:

2 adult ICUs at Tianjin Third

Central Hospital, tertiary hospital, China

Funding and conflicts of interest:

“This research was funded by Tianjin Key Medical Discipline (Specialty)

Construction Project.”

“The authors declare no conflicts of interest.”

Inclusion criteria:

• Age ≥ 18 years old
• with mechanical ventilation

expected for at least 72 hours

• RASS score ≥ 3 (eligible for delirium assessment),
• admitted to single-bed rooms in the ICU

Exclusion criteria:

• presence of a preexisting condition interfering with the assessment of delirium (e.g., tetraplegia, impaired hearing or vision, dementia)
• mechanical ventilation ≥ 48 hours before ICU admission,
• survival prognosis of less than 3 months,
• second admission during the study period

N total at baseline:

Intervention: 135

Control:135

Included in analysis:
I: 123

C: 120

Important prognostic factors²:

age ± SD:

I:54.88y ± 12.29

C:52.78y ±10.83

Sex:

I: 70/123; 57% M

C: 62/120; 52% M

Groups comparable at baseline.

Multicomponent intervention

1. Pain monitoring and management

2. Light sedation and daily awakening

3. Early exercise

4. Sleep promotion

5. Delirium monitoring

The PAD care bundle of interventions was implemented starting

from the patient's ICU admission until their discharge from the ICU, transfer to another medical center or ward, or death. This interdisciplinary, multi component, evidence-based protocol consisted of five major components.

For details, see publication

Usual care

Length of follow-up:

Up to discharge from the ICU and then surveys at 3 and 6 months after ICU discharge

Loss-to-follow-up & incomplete outcome data:

First analysis:

I: 120/135 (88.9%) in analysis;

C: 123/135 (91.1%) in analysis

8-11 percent not included in analysis

6 month FU:

I: 40% not analysed (giving up treatment, mechanical ventilation < 72h, lost contact, death)

C: 36.3% not analysed (giving up treatment, mechanical ventilation < 72h, lost contact, death)

Incidence of delirium

Delirium* (n and %)

I: 29/123, 23.58

C: 48/120, 40.00

OR = 0.46, 95% CI [0.23, 0.92]; adjusting for gender, age, APACHE II score, history of hypertension,

and comorbidity of sepsis

p = .028

Delirium duration, mean SD

I: 2.83 (SD 1.20) days

C: 4.02 (SD 1.99) days

 MD was -1.19 (95% CI -1.60 to -0.78)

Duration of ICU stay,

ICU LOS (days)

I: 7.88 ± 2.89

C: 10.13 ± 3.41

Quality of life

Not reported

Mortality

28-day ICU mortality (n and %)

I: 27/123, 21.95%

C: 30/120; 25.00%

Adverse events

Not reported

*Nurses assessed the patients for delirium once every 8 hours

using the Confusion Assessment Method for the ICU (CAMICU;

Selim et al., 2018). Additional assessments were conducted

when the participant's level of consciousness changed.

Deng 2020

Yes

No (no systematic search)

Unclear

Yes

Not applicable

yes

yes

Yes

Yes

Liang 2021

Yes

Yes

Unclear

Yes

Not applicable

yes

yes

Yes

Yes

Study reference

(first author, publication year)

Was the allocation sequence adequately generated?

Definitely yes

Probably yes

Probably no

Definitely no

Was the allocation adequately concealed?

Definitely yes

Probably yes

Probably no

Definitely no

Blinding:

• Was knowledge of the allocated
• interventions adequately prevented?
• Were patients blinded?
• Were healthcare providers blinded?
• Were data collectors blinded?
• Were outcome assessors blinded?
• Were data analysts blinded?

Definitely yes

Probably yes

Probably no

Definitely no

Was loss to follow-up (missing outcome data) infrequent?

Definitely yes

Probably yes

Probably no

Definitely no

Are reports of the study free of selective outcome reporting?

Definitely yes

Probably yes

Probably no

Definitely no

Was the study apparently free of other problems that could put it at a risk of bias?

Definitely yes

Probably yes

Probably no

Definitely no

Overall risk of bias

If applicable/necessary, per outcome measure

LOW

Some concerns

HIGH

Akpinar, 2021

Definitely yes

Reason: “were included in the study and then assigned to the experimental and control groups via the block randomization method. A research team member not involved in either subject recruitment or the intervention processes prepared the random assignment schedule, which was generated by the computer software Research Randomizer.”

Definitely yes

Reason: “Group assignments were placed in sealed envelopes and revealed sequentially at the time of randomization.”

Probably no

Reason: patient blinding not possible, other details not reported

Definitely yes

Reason: all allocated patients included in analysis

Probably yes

Reason: announced outcomes reported; trial not registered

No information

Reason: funding and conflicts described; unclear whether intention-to-treat protocol was used and whether data was incomplete

Some concerns

Reason: no registration, blinding not reported; protocol for missing data and analysis unclear

Faustino, 2022

Definitely yes

Reason: “Randomization was performed in random blocks of 4, 6, and 8 participants with the RStudio randomization system (Boston, MA, USA).”

Definitely yes

Reason: “Allocation concealment was ensured by opaque envelopes, sequentially

numbered, and sealed. This process was carried out by a professional, who was external to the research team. The envelopes were opened only after they had been irreversibly assigned to the participants”

Definitely no

Reason: ‘Due to characteristics of the intervention bundle, it was not possible

to blind participants, research staff, and ICU care providers’

Probably yes

Reason: no, both groups lost 10% of patients due to comparable reasons

Probably yes

Reason: trials registered (Brazilian Registry of Clinical Trials (ReBEC), identifier RBR-6xq95s) and announced outcomes are reported

Probably yes

Reason:

‘Enrolled patients were included in the intention-to-treat analysis.

‘

Some concerns

Reason: blinding issues inherent to type of intervention

Kasapoglu, 2022

Definitely yes

Reason: “A blinded statistician generated the allocation table.”

Probably no

Reason: concealment of allocation not described

Definitely no

Reason: “nurses did not know which group patients were in”.

“the same authors administered all the interventions in this study and collected data”

Blinding of data analysts not reported

Definitely no

Reason: 3, 9 and 23% of lost to follow-up

Probably yes

Reason: announced outcomes reported; trial not registered

Probably no

Reason: 3, 9 and 23% of lost to follow-up; no intention-to-treat protocol was used

Some concerns

Reason: some baseline differences; blinding issues; lost to FU not balances between groups; protocol for missing data and analysis unclear

Rood, 2021

Definitely no

“Using the stepped-wedge method, all centers started as controls, and every second month, the program was implemented in a randomly assigned center.”

Probably no

“Using the stepped-wedge method, all centers started as controls, and every second month, the program was implemented in a randomly assigned center.”

Probably no

“Because of the nature of the interventions, blinding was not possible. Using the stepped-wedge method, all centers started as controls, and every second month, the program was implemented in a randomly assigned center.”

Definitely yes

All patients in ITT analysis; clear description of data and per protocol analysis

Definitely yes

Reason: announced outcomes reported; trial not registered

Definitely yes

Reason: funding and conflicts described; protocol registered; funding and conflicts reported; data and missing data reported

Low concerns

Wang, 2022

Probably yes

“A computer was

used to generate the random numbers used for group assignments.”

No information

No information

Definitely no

Reason: 11.1 and 8.9% of patients were not included in the primary analysis

Probably yes

Reason: announced outcomes reported; trial not registered

Probably no

Reason: 3, 9 and 23% of lost to follow-up; no intention-to-treat protocol was used; protocol not registered

Some concerns

Reason: possibly blinding issues; relatively high proportion lost to follow up; protocol for missing data and analysis unclear; trial not registered

Reference

Reason for exclusion

Al-Qadheeb NS, Balk EM, Fraser GL, Skrobik Y, Riker RR, Kress JP, Whitehead S, Devlin JW. Randomized ICU trials do not demonstrate an association between interventions that reduce delirium duration and short-term mortality: a systematic review and meta-analysis. Crit Care Med. 2014 Jun;42(6):1442-54. doi: 10.1097/CCM.0000000000000224. PMID: 24557420; PMCID: PMC4799649.

Included studies do not meet PICO

Arttawejkul P, Reutrakul S, Muntham D, Chirakalwasan N. Effect of Nighttime Earplugs and Eye Masks on Sleep Quality in Intensive Care Unit Patients. Indian J Crit Care Med. 2020 Jan;24(1):6-10. doi: 10.5005/jp-journals-10071-23321. PMID: 32148342; PMCID: PMC7050172.

N < 10 per arm

Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Med. 2019 Jan;45(1):1-12. doi: 10.1007/s00134-018-5452-x. Epub 2018 Nov 30. PMID: 30506354.

Relevant studies included in other review

Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263-306. doi: 10.1097/CCM.0b013e3182783b72. PMID: 23269131.

Design

Burry LD, Hutton B, Guenette M, Williamson D, Mehta S, Egerod I, Kanji S, Adhikari NK, Moher D, Martin CM, Rose L. Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses. Syst Rev. 2016 Sep 8;5(1):153. doi: 10.1186/s13643-016-0327-0. PMID: 27609018; PMCID: PMC5016934.

Design

Burry LD, Cheng W, Williamson DR, Adhikari NK, Egerod I, Kanji S, Martin CM, Hutton B, Rose L. Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. Intensive Care Med. 2021 Sep;47(9):943-960. doi: 10.1007/s00134-021-06490-3. Epub 2021 Aug 11. PMID: 34379152; PMCID: PMC8356549.

Design

Chen TJ, Traynor V, Wang AY, Shih CY, Tu MC, Chuang CH, Chiu HY, Chang HR. Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults: A systematic review and network meta-analysis. Int J Nurs Stud. 2022 Jul;131:104239. doi: 10.1016/j.ijnurstu.2022.104239. Epub 2022 Mar 28. PMID: 35468538.

Design

Chen YF, Chang MY, Chow LH, Ma WF. Effectiveness of Music-Based Intervention in Improving Uncomfortable Symptoms in ICU Patients: An Umbrella Review. Int J Environ Res Public Health. 2021 Nov 1;18(21):11500. doi: 10.3390/ijerph182111500. PMID: 34770015; PMCID: PMC8582781.

Design

Contreras CCT, Páez-Esteban AN, Rincon-Romero MK, Carvajal RR, Herrera MM, Castillo AHDD. Nursing intervention to prevent delirium in critically ill adults. Rev Esc Enferm USP. 2021 Apr 16;55:e03685. doi: 10.1590/S1980-220X2019035003685. PMID: 33886913.

Wrong design

Dehghani S, Asadizaker M, Adineh M, Maraghi E, Akbarian S, Ramezani B. Multidimensional Nursing Interventions effect on Delirium and Hospital Admission Duration. International Journal of Pharmaceutical and Phytopharmacological Research. April 2020: 10 (2): 67-73.

Does not meet PICO (I)

Fahimi K, Abbasi A, Zahedi M, Amanpour F, Ebrahimi H. The effects of multimedia education on postoperative delirium in patients undergoing coronary artery bypass graft: A randomized clinical trial. Nurs Crit Care. 2020 Nov;25(6):346-352. doi: 10.1111/nicc.12473. Epub 2019 Sep 18. PMID: 31532055.

Does not meet PICO (P, I)

Finotto S, Artioli G, Davoli L, Barbara B. Interventi infermieristici nella prevenzione del delirium in Unità Coronarica: uno studio randomizzato [Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomized study]. Prof Inferm. 2006 Oct-Dec;59(4):228-32. Italian. PMID: 17320017.

Does not meet PICO

Flannery AH, Oyler DR, Weinhouse GL. The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework. Crit Care Med. 2016 Dec;44(12):2231-2240. doi: 10.1097/CCM.0000000000001952. PMID: 27509391.

Relevant studies included in other review

Garcia Guerra G, Almeida L, Zorzela L, King-Jones S, Joffe AR, Hartling L, Jou H, Vohra S; Canadian Critical Care Trials Group. Efficacy of music on sedation, analgesia and delirium in critically ill patients. A systematic review of randomized controlled trials. J Crit Care. 2019 Oct;53:75-80. doi: 10.1016/j.jcrc.2019.06.006. Epub 2019 Jun 4. PMID: 31202161.

No meta-analysis

Golubovic J, Neerland BE, Aune D, Baker FA. Music Interventions and Delirium in Adults: A Systematic Literature Review and Meta-Analysis. Brain Sci. 2022 Apr 28;12(5):568. doi: 10.3390/brainsci12050568. PMID: 35624955; PMCID: PMC9138821.

No meta-analysis

Huang S, Xu J, Du Y, Wang Y, Wei H, Wei G, Hu M. The effect of evidence-based cluster nursing intervention on the incidences of delirium and the prognoses of ICU patients. Am J Transl Res. 2021 Jul 15;13(7):8309-8315. PMID: 34377321; PMCID: PMC8340266.

Does not meet PICO (I)

Jaber S, Bahloul H, Guétin S, Chanques G, Sebbane M, Eledjam JJ. Effets de la musicothérapie en réanimation hors sédation chez des patients en cours de sevrage ventilatoire versus des patients non ventilés [Effects of music therapy in intensive care unit without sedation in weaning patients versus non-ventilated patients]. Ann Fr Anesth Reanim. 2007 Jan;26(1):30-8. French. doi: 10.1016/j.annfar.2006.09.002. Epub 2006 Nov 3. PMID: 17085009.

Language

Kang J, Lee M, Ko H, Kim S, Yun S, Jeong Y, Cho Y. Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: A systematic review and meta-analysis. J Crit Care. 2018 Dec;48:372-384. doi: 10.1016/j.jcrc.2018.09.032. Epub 2018 Sep 29. PMID: 30300863.

Does not meet PICO (P)

Khan SH, Xu C, Purpura R, Durrani S, Lindroth H, Wang S, Gao S, Heiderscheit A, Chlan L, Boustani M, Khan BA. Decreasing Delirium Through Music: A Randomized Pilot Trial. Am J Crit Care. 2020 Mar 1;29(2):e31-e38. doi: 10.4037/ajcc2020175. PMID: 32114612; PMCID: PMC7666845.

Does not meet PICO (C)

Liao J, Kui C, Zhou Y, Huang L, Zuo D, Huang Y, Pan R. Effect of Programmed Comprehensive Nursing for Postoperative Delirium in Intensive Care Unit Patients. Evid Based Complement Alternat Med. 2022 May 11;2022:1227659. doi: 10.1155/2022/1227659. PMID: 35600946; PMCID: PMC9117019.

Does not meet PICO (P)

Litton E, Carnegie V, Elliott R, Webb SA. The Efficacy of Earplugs as a Sleep Hygiene Strategy for Reducing Delirium in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med. 2016 May;44(5):992-9. doi: 10.1097/CCM.0000000000001557. PMID: 26741578.

Design / search

Lulu, Lv. Effect of earplugs and eye masks on sleep quality and delirium in intensive care patients. Critical Care & Shock - Volume 22, Issue 1, pp. 66-66 - published 2019-01-01

Conference abstract

Luther R, McLeod A. The effect of chronotherapy on delirium in critical care - a systematic review. Nurs Crit Care. 2018 Nov;23(6):283-290. doi: 10.1111/nicc.12300. Epub 2017 May 15. PMID: 28508438.

Design

Mailhot T, Cossette S, Côté J, Bourbonnais A, Côté MC, Lamarche Y, Denault A. A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study. Nurs Crit Care. 2017 Jul;22(4):221-228. doi: 10.1111/nicc.12288. Epub 2017 Mar 31. PMID: 28371230.

Does not meet PICO (C)

Matsuura Y, Ohno Y, Toyoshima M, Ueno T. Effects of non-pharmacologic prevention on delirium in critically ill patients: A network meta-analysis. Nurs Crit Care. 2022 May 27. doi: 10.1111/nicc.12780. Epub ahead of print. PMID: 35624556.

Relevant studies included in other review

Moon KJ, Lee SM. The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial. Int J Nurs Stud. 2015 Sep;52(9):1423-32. doi: 10.1016/j.ijnurstu.2015.04.021. Epub 2015 May 19. PMID: 26032729.

Included in review

Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA. 2017 Sep 26;318(12):1161-1174. doi: 10.1001/jama.2017.12067. PMID: 28973626; PMCID: PMC5717753.

Does not meet PICO (P)

Pieri M, De Simone A, Rose S, De Domenico P, Lembo R, Denaro G, Landoni G, Monaco F. Trials Focusing on Prevention and Treatment of Delirium After Cardiac Surgery: A systematic Review of Randomized Evidence. J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1641-1654. doi: 10.1053/j.jvca.2019.09.028. Epub 2019 Sep 24. PMID: 31668634.

Does not meet PICO (P)

Potharajaroen S, Tangwongchai S, Tayjasanant T, Thawitsri T, Anderson G, Maes M. Bright light and oxygen therapies decrease delirium risk in critically ill surgical patients by targeting sleep and acid-base disturbances. Psychiatry Res. 2018 Mar;261:21-27. doi: 10.1016/j.psychres.2017.12.046. Epub 2017 Dec 18. PMID: 29276990.

Included in review

Rains J, Chee N. The role of occupational and physiotherapy in multi-modal approach to tackling delirium in the intensive care. J Intensive Care Soc. 2017 Nov;18(4):318-322. doi: 10.1177/1751143717720589. Epub 2017 Jul 18. PMID: 29123562; PMCID: PMC5661800.

Design

Reznik ME, Slooter AJC. Delirium Management in the ICU. Curr Treat Options Neurol. 2019 Nov 14;21(11):59. doi: 10.1007/s11940-019-0599-5. PMID: 31724092.

Design / search

Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016 Mar 11;3:CD005563. doi: 10.1002/14651858.CD005563.pub3. PMID: 26967259.

Does not meet PICO (P)

Simons KS, Laheij RJ, van den Boogaard M, Moviat MA, Paling AJ, Polderman FN, Rozendaal FW, Salet GA, van der Hoeven JG, Pickkers P, de Jager CP. Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial. Lancet Respir Med. 2016 Mar;4(3):194-202. doi: 10.1016/S2213-2600(16)00025-4. Epub 2016 Feb 16. PMID: 26895652.

Included in review

Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care. 2012 May 4;16(3):R73. doi: 10.1186/cc11330. PMID: 22559080; PMCID: PMC3580615.

Included in review

Wassenaar A, Rood P, Schoonhoven L, Teerenstra S, Zegers M, Pickkers P, van den Boogaard M. The impact of nUrsiNg DEliRium Preventive INnterventions in the Intensive Care Unit (UNDERPIN-ICU): A study protocol for a multi-centre, stepped wedge randomized controlled trial. Int J Nurs Stud. 2017 Mar;68:1-8. doi: 10.1016/j.ijnurstu.2016.11.018. Epub 2016 Dec 8. PMID: 28013104.

Protocol