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Development of a non-pharmacologic delirium management bundle in paediatric intensive care units
Rikke Louise Stenkjaer1, Suzanne Forsyth Herling2, Ingrid Egerod3,4
1Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Non-pharmacologic interventions can reduce delirium in pediatric intensive care units (PICU). This study developed an age-specific bundle of non-pharmacologic interventions for PICU patients to manage delirium.
Area of Science:
- Pediatric intensive care
- Delirium management
- Evidence-based practice
Background:
- Delirium is a significant concern in pediatric intensive care units (PICU).
- Non-pharmacologic interventions show promise in reducing delirium incidence.
- A consensus-based approach is needed to guide these interventions.
Purpose of the Study:
- To achieve expert consensus on non-pharmacologic interventions for pediatric delirium.
- To develop an age-specific delirium management bundle for PICU patients.
Main Methods:
- A two-round online Delphi study involving PICU experts from diverse global regions.
- Questionnaire development based on literature review across cognition, sleep, and physical activity support domains.
- Expert rating of intervention feasibility and importance, with analysis of agreement levels.
Main Results:
- Fifty-three of 74 (72%) experts completed the first round; 45 of 74 (61%) completed the second.
- Key interventions identified include establishing daily routines, managing light exposure, scheduling sleep, ensuring sensory aids, and encouraging parental presence.
- Interventions were ranked by importance across age groups (0-2, 3-5, 6-18 years).
Conclusions:
- An age-specific non-pharmacologic delirium bundle was developed based on expert consensus.
- This bundle provides a framework for managing delirium in PICU settings.
- The bundle is ready for clinical testing to evaluate its effectiveness in reducing pediatric delirium.
Background:
Non-pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU).
Aim:
To explore expert opinions and generate informed consensus decisions regarding the content of a non-pharmacologic delirium bundle to manage delirium in PICU patients.
Study Design:
A two-round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated.
Results:
We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9-point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0-2, 3-5, and 6-18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence.
Conclusions:
Based on expert consensus, we developed an age-specific non-pharmacologic delirium bundle of interventions to manage delirium in PICU patients.
Relevance To Clinical Practice:
An age-specific Non-Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium.
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