Abstract
BackgroundDelirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care.MethodsThe primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group. The intervention consists of family-partnered delirium prevention, detection, and management, while the control group will receive usual care. Delirium, depression, and anxiety will be measured using validated tools, and participants will be followed for 1- and 3-months post-ICU discharge. All analyses will be intention-to-treat and adjusted for pre-identified covariates. Ethical approval has been granted by the University of Calgary Conjoint Health Research Ethics Board (REB19–1000) and the trial registered. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.DiscussionCritically ill patients are frequently unable to participate in their own care, and partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families.Trial registrationRegistered September 23, 2019 on Clinicaltrials.gov NCT04099472.
Highlights
Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes
Previous research demonstrates that family members of critically ill patients want to assist with nonpharmacological delirium prevention activities, but most family members do not possess enough delirium knowledge to be effective partners [58, 59]
These data will help us understand the effect that a family member’s participation in delirium prevention, detection and management will have on family-centered psychological outcomes
Summary
Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Patients admitted to the Intensive Care Unit (ICU) are the sickest in the healthcare system; they have complex medical problems that require urgent treatment with life sustaining technologies [1]. Within this context, one of the largest challenges in the care of critically ill patients is the development of delirium. Members of critically ill patients are exposed to high levels of stress and are at risk of developing stress-related complications during and after the ICU stay, including sleep disturbances, anxiety, and depression [13]. ICU patients, family members, providers and decisionmakers (ICU stakeholders) recognize the enormity of this issue and stakeholder groups have identified delirium detection and management as a top quality improvement opportunity [26,27,28,29,30]
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