Effectiveness Of Bundle Interventions on ICU Delirium: A Meta-Analysis

Abstract

Background: Bundle interventions are often used to prevent and manage ICU delirium, but different outcomes were found across studies. We aimed to evaluate the impact of bundle interventions on ICU delirium incidence and other clinical outcomes. Methods: We conducted a meta-analysis of randomized clinical trials, controlled trials or before-after studies that related to bundle interventions from January 2000 to October 2019. The primary outcome was ICU delirium incidence. Data were pooled by random- or fixed-effects models. Effect size measures were mean difference (MD), or risk ratio (RR) with 95% confidence intervals (CI). Findings: Twenty-five studies with a total of 25,328 adult participants were included in the meta-analysis. The incidence of ICU delirium was reduced by 22% (RR=0·78; 95%CI, 0·70-0·88) in intervention group. Meta-analysis showed that bundle interventions was associated with shortening the duration of ICU delirium (MD=-1·83days; 95% CI, -2·39 to -1·27), increasing ventilator-free days (MD=2·53days; 95%CI, 1·31-3·75), shortening ICU length of stay (MD=-1·04days; 95%CI, -1·59 to -0·50), decreasing in-hospital mortality by 17% (RR=0·83; 95%CI, 0·69 to 0·99) and 28-day mortality by 22% (RR=0·78; 95%CI, 0·63-0·96). Interpretation: Bundle interventions are effective in reducing the incidence and duration of ICU delirium. The meta-analysis supports the recommendation that bundle interventions have shown improved outcomes in ICU patients. Funding Statement: This study was supported by Grant 71661167008 from the National Natural Science Foundation of China. Declaration of Interests: The authors declare that they have no conflicts of interest.