Abstract
BackgroundThe prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable.Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients. The conclusions of the reviews showed conflicting results. Despite this unclear evidence, antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients.The objective of this overview of reviews is to critically assess the evidence of reviews of randomised clinical trials on the effect of pharmacological management and prevention of delirium in ICU patients.Methods/designWe will search for reviews in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database.Two authors will independently select references for inclusion using Covidence, extract data and assess the methodological quality of the included systematic reviews using the ROBIS tool. Any disagreement will be resolved by consensus.We will present the data as a narrative synthesis and summarise the main results of the included reviews. In addition, we will present an overview of the bias risk assessment of the systematic reviews.DiscussionResults of this overview may establish a way forward to find and update or to design a high quality systematic review assessing the effects of the most promising pharmacological intervention for delirium in ICU patients.Systematic review registrationPROSPERO - CRD42016046628.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0391-5) contains supplementary material, which is available to authorized users.
Highlights
The prevalence of delirium in intensive care unit (ICU) patients is high
Ely et al [12] evaluated a smaller cohort of 224 ICU patients, and their results showed that delirium was independently associated with 3.2 (95% confidence interval (Cl) 1.4–7.7; P = .008) increased risk of 6-month mortality
Our conclusions will primarily be based on the systematic reviews assessed with low risk of bias according to ROBIS [66]
Summary
The prevalence of delirium in intensive care unit (ICU) patients is high. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients. The conclusions of the reviews showed conflicting results Despite this unclear evidence, antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients. Antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients The objective of this overview of reviews is to critically assess the evidence of reviews of randomised clinical trials on the effect of pharmacological management and prevention of delirium in ICU patients. The prevalence of delirium is highest in hospitalised older individuals and varies depending on the patient characteristics, setting of care, and sensitivity of the detection method. Delirium occurs in 9 to 87% of individuals postoperatively [8], in 40 to 60% of the spontaneously breathing patients in intensive care, in 60 to 89% of the mechanically ventilated patients in intensive care [9], and up to 83% of all individuals at the end of life [10]
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