Interventions for preventing intensive care unit delirium in adults

Area of Science:

• Critical Care Medicine
• Neuroscience
• Pharmacology

Background:

• Delirium is a common and serious complication in critically ill patients.
• Intensive care unit (ICU) delirium is associated with increased mortality, longer ventilation, and prolonged hospital stays.
• It also leads to long-term cognitive impairment and increased societal costs.

Purpose of the Study:

• To evaluate the effectiveness of preventive interventions for ICU delirium.
• To assess the impact of these interventions on mortality, delirium-free days, and length of stay.
• To determine effects on cognitive impairment and other patient outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases (CENTRAL, MEDLINE, Embase, etc.) up to April 2018.
• Included 12 RCTs involving 3885 adult ICU patients, assessing interventions like drugs, sedation, and physical/cognitive therapy.

Main Results:

• Haloperidol versus placebo showed no significant difference in ICU delirium rates (moderate-quality evidence).
• Haloperidol did not significantly affect in-hospital mortality, delirium-free days, ventilator-free days, or ICU length of stay.
• Physical and cognitive therapy interventions showed very low-quality evidence with no clear impact on outcomes.

Conclusions:

• There is likely little to no difference between haloperidol and placebo for preventing ICU delirium; further research is needed.
• Insufficient evidence exists to conclude the effects of physical and cognitive interventions on delirium.
• Further large-scale multicenter studies are warranted for other interventions like sedation and environmental modifications.