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Non-pharmacological interventions for delirium in critically ill children: a scoping review
Max Zilezinski1, Natascha-Elisabeth Denninger2,3, Antje Tannen4
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Clinical Nursing Science, Charité - Universitätsmedizin Berlin, Berlin, Germany max.zilezinski@charite.de.
Insights
Non-pharmacological interventions like mobilization and family involvement can help manage pediatric delirium in critically ill children. However, current evidence is limited, necessitating high-quality research with consistent outcomes.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Evidence-based practice
Background:
- Pediatric delirium is a common complication in critically ill children, associated with adverse outcomes.
- Identifying effective non-pharmacological strategies is crucial for improving patient care.
Purpose of the Study:
- To conduct a scoping review to identify non-pharmacological interventions for preventing or treating pediatric delirium.
- To synthesize the existing literature on these interventions in pediatric intensive care settings.
Main Methods:
- A comprehensive scoping review was performed across multiple databases (Medline, CINAHL, Cochrane, EMBASE, Web of Science) from 2000 to 2024.
- Studies involving critically ill children (0-18 years) examining non-pharmacological delirium interventions were included.
- Data extraction included intervention components, study design, and outcomes.
Main Results:
- Nine studies were included, identifying 16 distinct intervention components.
- Key interventions included promoting mobilization, family presence, sleep improvement, and standardized checklists.
- Evidence for the effectiveness of these interventions was inconsistent, with varied outcomes reported.
Conclusions:
- While various non-pharmacological interventions exist for pediatric delirium, the supporting evidence is limited.
- High-quality research with standardized outcomes is essential to evaluate the efficacy of these interventions.
- Further research is needed to establish best practices for non-pharmacological delirium management in pediatric intensive care.
Objectives:
Delirium is one of the most common forms of acute cerebral dysfunction in critically ill children, leading to increased morbidity and mortality. The aim was to identify studies describing or evaluating non-pharmacological interventions to prevent or treat paediatric delirium.
Design:
Scoping review.
Data Sources:
Searches were performed in Medline, CINAHL, Cochrane Library, Ovid (Journals), EMBASE and Web of Science from January 2000 to April 2023. A hand search and update were conducted on 01 June 2024.
Eligibility Criteria For Selecting Studies:
We included studies involving critically ill children (0-18 years) in intensive care settings that examined non-pharmacological interventions for the prevention or treatment of paediatric delirium. Only empirical studies and reviews with transparent methodology were considered.
Data Extraction And Synthesis:
Title and abstract screening and full-text review of articles were conducted by two reviewers based on prespecified inclusion criteria. Two reviewers extracted relevant information from the included studies in tabular form. Extracted variables included publication year, title, author(s), country, setting, population and age, design, sample size, intervention components, outcome(s) and findings.
Results:
Nine studies were included. In total, 16 different intervention components were identified. The most frequently reported components for preventing and treating paediatric delirium were promoting mobilisation, encouraging family presence and involvement, improving sleep, and standardised instruments or checklists for underlying aetiology. Most intervention studies were before-and-after studies; overall, seven different outcomes were used. Study results regarding the effects of delirium were inconsistent.
Conclusions:
Various non-pharmacological interventions are currently described to mitigate paediatric delirium, but the underlying evidence is limited. High-quality intervention research using relevant and comparable outcomes is needed to evaluate the effect of non-pharmacological interventions. Despite employing a comprehensive search strategy, we must consider the possibility that relevant articles were overlooked.
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