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- Title
The Impact of Nursing Delirium Preventive Interventions in the ICU: A Multicenter Cluster-randomized Controlled Clinical Trial.
- Authors
Rood, Paul J T; Zegers, Marieke; Ramnarain, Dharmanand; Koopmans, Matty; Klarenbeek, Toine; Ewalds, Esther; van der Steen, Marijke S; Oldenbeuving, Annemarie W; Kuiper, Michael A; Teerenstra, Steven; Adang, Eddy; van Loon, Lex M; Wassenaar, Annelies; Vermeulen, Hester; Pickkers, Peter; van den Boogaard, Mark; UNDERPIN-ICU Study Investigators
- Abstract
Rationale: Delirium is common in critically ill patients and is associated with deleterious outcomes. Nonpharmacological interventions are recommended in current delirium guidelines, but their effects have not been unequivocally established. Objectives: To determine the effects of a multicomponent nursing intervention program on delirium in the ICU. Methods: A stepped-wedge cluster-randomized controlled trial was conducted in ICUs of 10 centers. Adult critically ill surgical, medical, or trauma patients at high risk of developing delirium were included. A multicomponent nursing intervention program focusing on modifiable risk factors was implemented as standard of care. The primary outcome was the number of delirium-free and coma-free days alive in 28 days after ICU admission. Measurements and Main Results: A total of 1,749 patients were included. Time spent on interventions per 8-hour shift was median (interquartile range) 38 (14-116) minutes in the intervention period and median 32 (13-73) minutes in the control period ( P = 0.44). Patients in the intervention period had a median of 23 (4-27) delirium-free and coma-free days alive compared with a median of 23 (5-27) days for patients in the control group (mean difference, -1.21 days; 95% confidence interval, -2.84 to 0.42 d; P = 0.15). In addition, the number of delirium days was similar: median 2 (1-4) days (ratio of medians, 0.90; 95% confidence interval, 0.75 to 1.09; P = 0.27). Conclusions: In this large randomized controlled trial in adult ICU patients, a limited increase in the use of nursing interventions was achieved, and no change in the number of delirium-free and coma-free days alive in 28 days could be determined. Clinical trial registered with www.clinicaltrials.gov (NCT03002701).
- Publication
American journal of respiratory and critical care medicine, 2021, Vol 204, Issue 6, p682
- ISSN
1535-4970
- Publication type
Journal Article
- DOI
10.1164/rccm.202101-0082OC