Abstract
BackgroundDelirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence.MethodsWe will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software.DiscussionThis systematic review will address the existing knowledge gap regarding best practices for delirium prevention in critically ill adults by synthesizing evidence from trials of pharmacological, non-pharmacological, and multi-component interventions administered in or prior to transfer to the ICU. Use of network meta-analysis will clarify which delirium prevention strategies are most effective in improving clinical outcomes while causing least harm. The network meta-analysis is a novel approach and will provide knowledge users and decision makers with comparisons of multiple interventions of delirium prevention strategies.Systematic review registrationPROSPERO CRD42016036313Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0327-0) contains supplementary material, which is available to authorized users.
Highlights
Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults
Use of network meta-analysis will clarify which delirium prevention strategies are most effective in improving clinical outcomes while causing least harm
Delirium is a syndrome commonly experienced by patients in the intensive care unit (ICU), and is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness [1]
Summary
This systematic review protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines [23]. The domains are as follows: (1) random sequence generation (i.e., selection bias); (2) allocation concealment (i.e., selection bias); (3) blinding of participants and personnel (i.e., performance bias); (4) blinding of outcomes assessment (i.e., detection bias); (5) incomplete outcome data (i.e., attrition bias); (6) selective reporting; and (7) other bias (e.g., source of funding) For hard endpoints such as mortality, incidence of delirium, and duration of mechanical ventilation, a lack of blinding does not immediately warrant a judgment of high risk of bias as this aspect of study design is not considered to have a biasing effect on the endpoints.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
