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Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative
Kyua Kim1, Ju Hee Jeong2, Eun Kyoung Choi3
1Department of Nursing, Yonsei University Graduate School & Pediatric Intensive Care Unit, Severance Hospital, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Insights
Non-pharmacological interventions effectively manage pediatric delirium in hospitalized children. Further research is needed to identify the optimal strategy for preventing and treating delirium in this population.
Area of Science:
- Pediatric critical care medicine
- Child psychology
- Evidence-based healthcare
Background:
- Delirium is a significant complication in hospitalized children, necessitating effective preventive strategies.
- Existing research on pediatric delirium interventions lacks comprehensive analysis, highlighting a need for systematic review.
- Understanding non-pharmacological approaches is crucial for improving care and guiding future research.
Conclusions:
- Non-pharmacological interventions demonstrate effectiveness and safety in managing pediatric delirium.
- Current data presents challenges in definitively identifying the most effective non-pharmacological intervention for hospitalized children.
- Further research is warranted to refine and optimize non-pharmacological strategies for pediatric delirium.
Background:
Delirium is a serious complication experienced by hospitalized children. Therefore, preventive management strategies are recommended for these patients. However, comprehensive analyses of delirium interventions in children remain insufficient. Specifically, this systematic review aimed to summarize non-pharmacological interventions for pediatric delirium, addressing the urgent need for a comprehensive understanding of effective strategies. We also explored frequently measured outcome variables to contribute evidence for future research on delirium outcomes in children.
Methods:
This systematic review searched articles from PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica databases. The eligibility criteria were formed under the population, intervention, comparator, outcome, and study design framework. Studies were included if they involved (1) children aged under 18 years receiving hospital care, (2) non-pharmacological delirium interventions, (3) comparators involving no intervention or pharmacological delirium interventions, and (4) outcomes measuring the effectiveness of non-pharmacological delirium interventions. Only peer-reviewed articles published in English were included.
Results:
Overall, 16 studies were analyzed; of them, 9 assessed non-pharmacological interventions for emergence delirium and 7 assessed interventions for pediatric delirium. The intervention types were grouped as follows: educational (n = 5), multicomponent (n = 6), and technology-assisted (n = 5). Along with pediatric and emergence delirium, the most frequently measured outcome variables were pain, patient anxiety, parental anxiety, pediatric intensive care unit length of stay, agitation, analgesic consumption, and postoperative maladaptive behavior.
Conclusions:
Non-pharmacological interventions for children are effective treatments without associated complications. However, determining the most effective non-pharmacological delirium intervention for hospitalized children based on current data remains challenging.
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