非药物干预预防重症成人谵妄的比较有效性：系统评价和网络荟萃分析

分享智慧

共同成长Abstract

Background

Delirium presents a serious health problem in critically ill patients in intensive care units. However, knowledge regarding the selections of the optimal non-pharmacological interventions remains unclear.

Objectives

To compare the effects of non-pharmacological interventions by combining direct and indirect evidence on the incidence and duration of delirium in intensive care units.

Design

A systematic review and network meta-analysis.

Data sources

A comprehensive search of five electronic databases, including PubMed, EMBASE, CINAHL, Cochrane CENTRAL, and ProQuest Dissertations and Theses A&I were conducted. Only randomized control trials published from the inception to December 28, 2021 were included.

Review methods

Two reviewers independently screened the title and abstract for eligibility according to the inclusion and exclusion criteria. The random-effect network meta-analysis was used to estimate the comparative effects of non-pharmacological interventions in reducing delirium incidence and duration.

Results

A total of 29 studies with 7,005 critically ill patients were enrolled. Twenty-six and eleven studies reported the delirium incidence and duration, respectively. Component-based intervention comparison revealed that multicomponent strategy was the most effective non-pharmacological intervention compared to usual care in reducing incidence of ICU delirium (Odd ratio [OR]=0.43, 95%CI= 0.22-0.84) but not ICU delirium duration. Treatment-based intervention comparisons indicated that specific multi-treatment interventions significantly reduced the ICU delirium incidence and duration, particularly the involvement of early mobilization and family participation (ORs = 0.12 with 95%CI = 0.02 to 0.83; standardized mean difference = -1.34 with 95% CI = -2.52 to -0.16, respectively).

Conclusion

Our study suggests that the multicomponent strategy was the most effective non-pharmacological intervention in reducing the incidence of ICU delirium. Early mobilization and family participation involvement in non-pharmacological interventions seemed to be more effective in reducing the incidence of ICU delirium. These results of network-meta analysis could be an important evidence-based for clinical healthcare providers to optimize the critical care protocol.

摘要翻译（仅供参考）

背景

谵妄会给重症监护病房的危重病人带来严重的健康问题。然而，关于选择最佳非药物干预措施的知识仍不清楚。

目标

通过结合直接和间接证据来比较非药物干预对重症监护病房谵妄发生率和持续时间的影响。

设计

系统评价和网络荟萃分析。

数据源

对五个电子数据库进行了全面搜索，包括 PubMed、EMBASE、CINAHL、Cochrane CENTRAL 和 ProQuest Dissertations and Theses A&I。仅包括从开始到 2021 年 12 月 28 日发布的随机对照试验。

审查方法

两名评审员根据纳入和排除标准独立筛选标题和摘要的资格。随机效应网络荟萃分析用于估计非药物干预在减少谵妄发生率和持续时间方面的比较效果。

结果

共纳入 29 项研究，涉及 7,005 名危重患者。26 项和 11 项研究分别报告了谵妄的发生率和持续时间。基于成分的干预比较显示，与常规护理相比，多成分策略在降低 ICU 谵妄发生率方面是最有效的非药物干预（奇数比 [OR] = 0.43，95% CI = 0.22-0.84），但不是 ICU 谵妄持续时间。基于治疗的干预比较表明，特定的多治疗干预显着降低了 ICU 谵妄的发生率和持续时间，特别是早期活动和家庭参与的参与（OR = 0.12，95%CI = 0.02 至 0.83；标准化均数差 = -1.34， 95% CI = -2.52 至 -0.16，分别）。

结论

我们的研究表明，多组分策略是降低 ICU 谵妄发生率的最有效的非药物干预措施。早期动员和家庭参与参与非药物干预似乎更有效地降低了 ICU 谵妄的发生率。网络元分析的这些结果可能是临床医疗保健提供者优化重症监护协议的重要循证依据。

原文链接：

https://doi.org/10.1016/j.ijnurstu.2022.104239

THE

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