Nursing intervention to prevent delirium in critically ill adults.

Claudia Consuelo Torres Contreras,Alfredo Hinestrosa Díaz Del Castillo,Astrid Nathalia Páez-Esteban,Raquel Rivera Carvajal,Marisela Márquez Herrera,Mayerli Katherine Rincon-Romero

doi:10.1590/s1980-220x2019035003685

Abstract

To determine the effectiveness of a nursing intervention for delirium prevention in critically ill patients. A quasi-experimental study was conducted with a non-equivalent control group and with evaluation before and after the intervention. 157 Patients were part of the intervention group and 134 of the control group. Patients were followed-up until they were discharged from the ICU or died. The incidence of delirium in both groups was compared. Additionally, the effect measures were adjusted for the propensity score. The incidence and incidence rate of delirium in the control group were 20.1% and 33.1 per 1000 person-days (CI 95% 22.7 to 48.3) and in the intervention group was 0.6% and 0.64 per 1000 person-days (CI 95% 0.22 to 11.09), respectively. The crude Hazard Ratio was 0.06 (CI 95% 0,008 to 0,45) and adjusted 0.07 (CI 95% 0,009 to 0,60). The number needed to be treated was six. Low incidence of delirium in critically ill patients intervened demonstrated the effectiveness of interventions. The average intervention time was 4 days with a 15-minutes dedication for each patient.

Highlights

Acute confusion or delirium is considered one of the most frequent syndromes in intensive care units (ICU); it constitutes a neurobehavioral disorder, underdiagnosed and undertreated, but potentially reversible and preventable[1].Delirium is considered as an alteration of the consciousness, diminution of the ability to pay attention to the environment, reduction of the ability to focus, maintain or direct the attention
The intervention was daily performed from admission to discharge from the ICU by two previously trained nurses; the intervention lasted approximately 15 minutes
Through the analysis of results, it is verified that nursing interventions applied in this study to prevent delirium in the ICU demonstrated to be efficient, despite the presence of precipitating and predisposing factors of patients in the intervention group.This is compatible with the meta-analysis performed with 4267 patients that showed that delirium probabilities were 53% lower in the intervention group compared to the control group (OR, 0.47, 95% CI, 0.38-0.58) . [18] Seven studies with multicomponent interventions significantly reduced incident delirium (relative risk (RR) 0.73, 95% CI 0.63-0.85)(25)

Summary

Introduction

Delirium is considered as an alteration of the consciousness, diminution of the ability to pay attention to the environment, reduction of the ability to focus, maintain or direct the attention. It comes with changes in cognitive functions that are not explained by previous or current dementia; its duration is variable and tends to fluctuate during the course of the day[2]. Mixed delirium is a combination of hyperactive and hypoactive delirium where a person can fluctuate between signs and symptoms of both[3]

Methods

Results

Discussion

Conclusion