Non-pharmacologic interventions for the prevention of delirium in the intensive care unit: An integrative review

Abstract

Background: Delirium in the intensive care unit (ICU) is associated with increased mortality, longer hospital stays, and increased odds of institutionalization after discharge. Delirium is a significant complication that occurs frequently in ICU yet lacks a standardized treatment protocol. Because of the limited effective pharmacologic treatments available for the management of delirium, non-pharmacologic interventions such as early mobilization, earplugs and blinds at night, music and natural sunlight during the day, continuous reorientation, and increased visitation and family participation are essential to integrate into the treatment plan for the management of delirium in the ICU.

Aim: To summarize evidence on the use of non-pharmacologic interventions for the reduction in incidence and duration of delirium in ICU patients and to integrate qualitative studies that explore the perception of delirium in the ICU from staff and patients' families to support the use of non-pharmacologic interventions.

Methods: For this integrative review, electronic databases PubMed, EMBASE, and Google Scholar were searched using the guidance of a librarian and second reviewer to find qualitative and quantitative studies that were published after 2005 and involved adult patients in the ICU.

Conclusion: Eight quantitative articles and four qualitative articles were chosen to be included in this review. All eight quantitative studies provide significant evidence (P < .05) for the efficacy of their interventions to provide benefit to at least one delirium-related outcome. The four qualitative research studies reviewed provide insight on delirium in the ICU from staff and patients' families who share a desire for the use of effective non-pharmacologic interventions.

Relevance to clinical practice: Non-pharmacologic interventions used for patients in the ICU may be efficacious in reducing the incidence and duration of delirium in adults. Non-pharmacologic interventions are feasible and supported by ICU staff and patients' families and should be considered in the care of the critically ill patient.

Keywords: ICU; delirium; intervention; non-pharmacological; prevention.