Delirium management in critically ill patients: an integrative review

Abstract

Introduction: The critically ill patient is at high risk of developing delirium, which is an independent predictor of mortality, morbidity, increased length of stay, health costs and safety incidents. The incidence of this disturbance can reach 80% in this population, with severe impact on short and long-term outcomes of patients and family. Objectives: To analyse and summarise evidence regarding nursing interventions that are effective on delirium management in critically ill patients. Methodology: For this integrative review, literature research was conducted in electronic databases MEDLINE, CINAHL and Cochrane Database of Systematic, as well as other sources, from January 2013 to September 2021. Results and Discussion: The search retrieved 140 documents, 135 obtained from electronic databases and five from other sources. After assessing eligibility, 22 final documents were obtained for data extraction and analysis. The results show that the implementation of multicomponent interventions have greater benefits in reducing delirium incidence and duration. Non-pharmacological interventions, like early mobilization and family participation, also stand out. Nurses play a significant role in delirium management, and this review can help nurses to choose interventions based on clinical evidence, improving the outcomes of the critically ill patient. Conclusion: The implementation of multicomponent interventions demonstrates greater benefits in reducing delirium incidence and duration, with impact on other person-centred outcomes. Further multicentric studies are needed to prove unequivocal benefits of engaging the family of critically ill adults with delirium, and its benefits in their outcomes.