Abstract
BackgroundDelirium prevention is crucial, especially in critically ill patients. Nonpharmacological multicomponent interventions for preventing delirium are increasingly recommended and technology-based interventions have been developed to support them. Despite the increasing number and diversity in technology-based interventions, there has been no systematic effort to create an overview of these interventions for in-hospital delirium prevention and reduction.ObjectiveThis systematic scoping review was carried out to answer the following questions: (1) what are the technologies currently used in nonpharmacological technology-based interventions for preventing and reducing delirium? and (2) what are the strategies underlying these currently used technologies?MethodsA systematic search was conducted in Scopus and Embase between 2015 and 2020. A selection was made in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were eligible if they contained any type of technology-based interventions and assessed delirium-/risk factor–related outcome measures in a hospital setting. Data extraction and quality assessment were performed using a predesigned data form.ResultsA total of 31 studies were included and analyzed focusing on the types of technology and the strategies used in the interventions. Our review revealed 8 different technology types and 14 strategies that were categorized into the following 7 pathways: (1) restore circadian rhythm, (2) activate the body, (3) activate the mind, (4) induce relaxation, (5) provide a sense of security, (6) provide a sense of control, and (7) provide a sense of being connected. For all technology types, significant positive effects were found on either or both direct and indirect delirium outcomes. Several similarities were found across effective interventions: using a multicomponent approach or including components comforting the psychological needs of patients (eg, familiarity, distraction, soothing elements).ConclusionsTechnology-based interventions have a high potential when multidimensional needs of patients (eg, physical, cognitive, emotional) are incorporated. The 7 pathways pinpoint starting points for building more effective technology-based interventions. Opportunities were discussed for transforming the intensive care unit into a healing environment as a powerful tool to prevent delirium.Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020175874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175874
Highlights
BackgroundDelirium is an acute brain dysfunction with a disturbance in attention, awareness, and cognition [1], which is common, especially in critically ill patients
Opportunities were discussed for transforming the intensive care unit into a healing environment as a powerful tool to prevent delirium
Delirium is frequently associated with a significant increase in the intensive care unit (ICU) length of stay [6], risk of long-term cognitive impairments [7], and 6-month mortality rates after leaving the ICU [8]
Summary
Delirium is an acute brain dysfunction with a disturbance in attention, awareness, and cognition [1], which is common, especially in critically ill patients. It occurs in about 40% of patients in the intensive care unit (ICU) [2], and in case of ventilated patients, the proportion goes up to about 65%-80% [2,3]. Nonpharmacological multicomponent interventions for preventing delirium are increasingly recommended and technology-based interventions have been developed to support them. Despite the increasing number and diversity in technology-based interventions, there has been no systematic effort to create an overview of these interventions for in-hospital delirium prevention and reduction
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