Abstract
BackgroundCritically ill patients have an increased risk of developing delirium during their intensive care stay. To date, pharmacological interventions have not been shown to be effective for delirium management but non-pharmacological interventions have shown some promise. The aim of this systematic review is to identify effective non-pharmacological interventions for reducing the incidence or the duration of delirium in critically ill patients.MethodsWe will search MEDLINE, EMBASE, CINAHL, Web of Science, AMED, psycINFO and the Cochrane Library. We will include studies of critically ill adults and children. We will include randomised trials and controlled trials which measure the effectiveness of one or more non-pharmacological interventions in reducing incidence or duration of delirium in critically ill patients. We will also include qualitative studies that provide an insight into patients and their families’ experiences of delirium and non-pharmacological interventions. Two independent reviewers will assess studies for eligibility, extract data and appraise quality. We will conduct meta-analyses if possible or present results narratively. Qualitative studies will also be reviewed by two independent reviewers, and a specially designed quality assessment tool incorporating the CASP framework and the POPAY framework will be used to assess quality.DiscussionAlthough non-pharmacological interventions have been studied in populations outside of intensive care units and multicomponent interventions have successfully reduced incidence and duration of delirium, no systematic review of non-pharmacological interventions specifically targeting delirium in critically ill patients have been undertaken to date. This systematic review will provide evidence for the development of a multicomponent intervention for delirium management of critically ill patients that can be tested in a subsequent multicentre randomised trial.Systematic review registrationPROSPERO CRD42015016625Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0254-0) contains supplementary material, which is available to authorized users.
Highlights
Ill patients have an increased risk of developing delirium during their intensive care stay
Several studies have identified a link between delirium and inhospital mortality [5, 12, 16, 26, 28, 33, 34]. These findings suggest that an increased duration of mechanical ventilation, intensive care unit (ICU) admission and hospital stay often contribute to long-term negative outcomes such as increased mortality and morbidity
Summary of findings tables For quantitative studies, we will use the principles of the Grading of Recommendations Assessment (GRADE) system [59] to assess the quality of the body of evidence associated with specific outcomes reported in the trials
Summary
Ill patients have an increased risk of developing delirium during their intensive care stay. Pharmacological interventions have not been shown to be effective for delirium management but non-pharmacological interventions have shown some promise. The aim of this systematic review is to identify effective non-pharmacological interventions for reducing the incidence or the duration of delirium in critically ill patients. Description of the condition Survivors of critical illness frequently experience ‘malfunction of the cognitive processes in the brain’, known as delirium [1]. Ill patients have an increased risk of developing delirium during their hospital stay. This often results from sepsis and disturbances in inflammation and coagulation pathways leading to microvascular thrombosis [3]. Critical illness disrupts circadian rhythm and sleep patterns and along with sedatives such as benzodiazepines that are commonly used to treat delirium in septic patients, can impair immunity and contribute to delirium [1, 4]
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