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Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis
Shan Zhang1, Yuan Han1, Qian Xiao1
1Department of Adult Care, School of Nursing, Capital Medical University, Beijing, China.
Critical Care Medicine
|December 17, 2020
Summary
Bundle interventions do not reduce intensive care unit (ICU) delirium prevalence or duration. However, they effectively decrease coma, shorten hospital stays, and reduce 28-day mortality, warranting further research.
Area of Science:
- Critical Care Medicine
- Evidence-Based Practice
- Patient Outcomes Research
Background:
- Delirium in the intensive care unit (ICU) is a common complication with significant adverse effects.
- Bundle interventions aim to mitigate ICU delirium and improve patient outcomes.
- The effectiveness of these interventions requires rigorous evaluation through systematic review and meta-analysis.
Purpose of the Study:
- To evaluate the impact of bundle interventions on ICU delirium prevalence and duration.
- To assess the effect of bundle interventions on other critical patient outcomes, including coma, ventilation duration, and mortality.
- To synthesize evidence from randomized clinical trials and cohort studies to inform clinical practice.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (Cochrane Library, PubMed, CINAHL, EMBASE, PsychINFO, MEDLINE) from January 2000 to July 2020.
- Included studies were randomized clinical trials and cohort studies examining ICU delirium and related adverse events.
- Data extraction and quality assessment were performed independently by two authors using standardized tools (Modified Jadad Score, Newcastle-Ottawa Scale).
Main Results:
- Eleven studies with 26,384 participants were included. Bundle interventions did not significantly reduce ICU delirium prevalence (RR 0.92; 95% CI, 0.68-1.24) or duration (MD -1.42 days; 95% CI, -3.06 to 0.22).
- Significant benefits were observed in reducing the proportion of patient-days with coma (RR 0.47; 95% CI, 0.39-0.57), shortening hospital length of stay (MD -1.47 days; 95% CI, -2.80 to -0.15), and decreasing 28-day mortality (RR 0.82; 95% CI, 0.69-0.99).
- No significant effects were found on ventilator-free days, mechanical ventilation days, ICU length of stay, or inhospital mortality.
Conclusions:
- Bundle interventions are not effective in reducing ICU delirium prevalence or duration.
- These interventions demonstrate efficacy in reducing coma, hospital length of stay, and 28-day mortality.
- Larger, high-quality randomized clinical trials are necessary to further elucidate the impact of bundle interventions on ICU delirium and other clinical outcomes.
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