Patients in the surgical intensive care unit (ICU) experience less delirium after a multicomponent nonpharmacologic intervention, according to the results of a recent study published in the journal CHEST.
Researchers assessed delirium and sleep quality in patients in the surgical intensive care unit at baseline and after beginning a unit-wide multicomponent nonpharmacologic intervention (ClinicalTrials.gov Identifier: NCT03313115). The intervention consisted of efforts to minimize unnecessary sound and light, provision of earplugs and eye masks at nighttime as well as raising blinds and promotion of physical activity during the day. Delirium was measured via the Confusion Assessment Method and sleep quality was measured using the Richards-Campbell Sleep Questionnaire.
Among the 646 patients admitted to the surgical ICU, measurements for 332 at baseline and 314 after intervention were available for analysis. The median age was 61 years, and 35% were women. Following intervention, when the outcomes of interest were assessed, it was determined that patients experienced fewer days of delirium vs before the intervention period (proportion [±SD] of ICU days, 15%±27% vs 20%±31%; with an adjusted pre-post decrease of 4.9%; P =.03). However, perceived sleep quality ratings did not change from baseline.
“In critically ill surgical ICU patients, we demonstrated that a [nonpharmacologic] environmental intervention to improve sleep-wake disruption was associated with a significant reduction in delirium,” the study authors. “Given the adverse outcomes and major healthcare costs associated with delirium, our findings suggest that simple environmental and staff behavioral interventions are feasible and should be a target of future multi-center trials.”
Tonna JE, Dalton A, Presson AP, et al. The effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical intensive care unit. CHEST. Published online March 24, 2021. doi:10.1016/j.chest.2021.03.030