Interventions to prevent and treat delirium: An umbrella review of randomized controlled trials

Nicola Veronese; Luisa Solimando; Francesco Bolzetta; Stefania Maggi; Jess G Fiedorowicz; Arnav Gupta; Nicholas Fabiano; Stanley Wong; Laurent Boyer; Guillaume Fond; Elena Dragioti; Ligia J Dominguez; Mario Barbagallo; Stefano Romagnoli; Giuseppe Bellelli; Marco Solmi

doi:10.1016/j.arr.2024.102313

Interventions to prevent and treat delirium: An umbrella review of randomized controlled trials

Ageing Res Rev. 2024 Apr 26:97:102313. doi: 10.1016/j.arr.2024.102313. Online ahead of print.

Authors

Nicola Veronese¹, Luisa Solimando², Francesco Bolzetta³, Stefania Maggi⁴, Jess G Fiedorowicz⁵, Arnav Gupta⁶, Nicholas Fabiano⁷, Stanley Wong⁸, Laurent Boyer⁹, Guillaume Fond⁹, Elena Dragioti¹⁰, Ligia J Dominguez¹¹, Mario Barbagallo², Stefano Romagnoli¹², Giuseppe Bellelli¹³, Marco Solmi¹⁴

Affiliations

¹ Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy. Electronic address: nicola.veronese@unipa.it.
² Geriatric Unit, Department of Medicine, University of Palermo, Palermo 90127, Italy.
³ Medical Department, Geriatric Unit, Azienda ULSS (Unità Locale Socio Sanitaria), 3 "Serenissima", Dolo-Mirano District, Dolo, Venice, Italy.
⁴ National Research Council, Neuroscience Institute, Padua, Italy.
⁵ Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada.
⁶ College of Public Health, Kent State University, Kent, OH, United States; Department of Medicine, University of Calgary, Calgary, AB, United States.
⁷ Department of Mental Health, The Ottawa Hospital, Ontario, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁹ AP-HM, Aix-Marseille Univ, CEReSS, Health Service Research and Quality of Life Centre, School of Medicine-La Timone Medical, Marseille, France; FondaMental Fondation, Créteil, France.
¹⁰ Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping 581 85, Sweden; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina 45500, Greece.
¹¹ Faculty of Medicine and Surgery, Kore University of Enna, Enna 94100, Italy.
¹² Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
¹³ School of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy; Acute Geriatric Unit, IRCCS San Gerardo, Monza 20900, Italy.
¹⁴ Department of Mental Health, The Ottawa Hospital, Ontario, Canada; Department of Psychiatry, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Ottawa, Ontario,Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.

PMID: 38677599
DOI: 10.1016/j.arr.2024.102313

Abstract

Delirium is a common condition across different settings and populations. The interventions for preventing and managing this condition are still poorly known. The aim of this umbrella review is to synthesize and grade all preventative and therapeutic interventions for delirium. We searched five databases from database inception up to March 15th, 2023 and we included meta-analyses of randomized controlled trials (RCTs) to decrease the risk of/the severity of delirium. From 1959 records after deduplication, we included 59 systematic reviews with meta-analyses, providing 110 meta-analytic estimates across populations, interventions, outcomes, settings, and age groups (485 unique RCTs, 172,045 participants). In surgery setting, for preventing delirium, high GRADE evidence supported dexmedetomidine (RR=0.53; 95%CI: 0.46-0.67, k=13, N=3988) and comprehensive geriatric assessment (OR=0.46; 95%CI=0.32-0.67, k=3, N=496) in older adults, dexmedetomidine in adults (RR=0.33, 95%CI=0.24-0.45, k=7, N=1974), A2-adrenergic agonists after induction of anesthesia (OR= 0.28, 95%CI= 0.19-0.40, k=10, N=669) in children. High certainty evidence did not support melatonergic agents in older adults for delirium prevention. Moderate certainty supported the effect of dexmedetomidine in adults and children (k=4), various non-pharmacological interventions in adults and older people (k=4), second-generation antipsychotics in adults and mixed age groups (k=3), EEG-guided anesthesia in adults (k=2), mixed pharmacological interventions (k=1), five other specific pharmacological interventions in children (k=1 each). In conclusion, our work indicates that effective treatments to prevent delirium differ across populations, settings, and age groups. Results inform future guidelines to prevent or treat delirium, accounting for safety and costs of interventions. More research is needed in non-surgical settings.

Keywords: Delirium; Meta-analysis; Prevention; Treatment; Umbrella review.

Publication types

Review