Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*

Zhang, Shan; Han, Yanming; Xiao, Qian; Li, Haibin; Wu, Ying

doi:10.1097/ccm.0000000000004773

Cited by 41 publications

(48 citation statements)

References 38 publications

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“…The sample sizes ranged from 59 to 4,870 participants, and the mean followup ranged from 2 weeks to 4.5 years. We assessed the trials' quality using the modified Jadad score scale, as described previously (44), and we found that among the 17 RCTs, 9 RCTs (52.94%) got a full score of seven, and only 3 RCTs (17.65%) were identified as low-quality trials because of the less than three score (Table 1). In most RCTs, TCM was associated with significant improvements in surrogate endpoints for stable angina, unstable angina, MI, SCAD, and coronary artery bypass grafting (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Traditional Chinese Medicine for Coronary Artery Disease Treatment: Clinical Evidence From Randomized Controlled Trials

Liang

2021

Front. Cardiovasc. Med.

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Traditional Chinese medicine has a history of more than 2,000 years and has been widely used in clinical practice. However, due to the lack of a reliable scientific basis, the role of traditional Chinese medicine in the prevention and treatment of coronary artery disease is not clear. At present, the existing randomized controlled trials about traditional Chinese medicine for coronary artery disease have defects, small sample sizes, and different results, so it is difficult to make a clear conclusion on the actual advantages and disadvantages of traditional Chinese medicine. In this review, the efficacy and safety of traditional Chinese medicine in the prevention and treatment of coronary artery disease were systematically evaluated through randomized controlled trials, most of which were double-blind trials. We reviewed 17 randomized controlled trials that included a total of 11,726 coronary artery disease patients. The methodological quality of the trials was generally high, with nine (52.94%) having a modified Jadad score of 7 and only three (17.65%) having a modified Jadad score of <3. There are 16 trials (94.12%) reporting safety; the safety of traditional Chinese medicine seems not to be inferior to that of mimetic, placebo, or western medications. Moreover, the results from 17 randomized controlled trials (100.00%) showed that traditional Chinese medicine can be applied as a complementary and alternative method to the primary and secondary prevention of coronary artery disease, and only six trials (35.29%) described adverse cardiovascular events specifically. However, it is necessary to assess the safety and efficacy of traditional Chinese medicine in treating coronary artery disease with long-term hard endpoints.

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Section: Discussionmentioning

confidence: 99%

Traditional Chinese Medicine for Coronary Artery Disease Treatment: Clinical Evidence From Randomized Controlled Trials

Liang

2021

Front. Cardiovasc. Med.

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“…Based on evidence of delirium bundle in the adult population, bundle intervention may decrease the incidence of delirium as well in the pediatric population (16,17). Nevertheless, a recent published metaanalysis failed to support that bundle interventions are effective in reducing ICU delirium prevalence and duration, although, it supported that bundle interventions are effective in reducing the proportion of patient-days with coma, hospital length of stay, and 28-day mortality (18).…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

et al. 2022

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Background and ObjectiveDelirium represents the most common form of acute cerebral dysfunction in critical illness. The prevention, recognition, and treatment of delirium must become the focus of modern pediatric intensive care, as delirium can lead to increased morbidity and mortality. The aim of this study is to evaluate the impact of a delirium bundle consisting of mainly non-pharmacological measures.Material and MethodsThis is a pre-/post-implementation study in an interdisciplinary pediatric intensive care unit of a tertiary care university hospital. In the pre-implementation period, pediatric intensive care delirium was monitored using the Sophia Observation withdrawal Symptoms and Pediatric Delirium scale. After introduction of a delirium bundle consisting of non-pharmacological prevention and treatment measures a period of 4 months was interposed to train the PICU staff and ensure that the delirium bundle was implemented consistently before evaluating the effects in the post-implementation period. Data collection included prevalence of delirium and withdrawal, length of PICU stay, duration of mechanical ventilation, and cumulative dose of sedatives and analgesics.ResultsA total of 792 critically ill children aged 0–18 years were included in this study. An overall delirium prevalence of 30% was recorded in the pre-implementation group and 26% in the post-implementation group (p = 0.13). A significant reduction in the prevalence of pediatric delirium from was achieved in the subgroup of patients under 5 years of age (27.9 vs. 35.8%, p = 0.04) and in patients after surgery for congenital heart disease (28.2 vs. 39.5%, p = 0.04). Young age, length of PICU stay, and iatrogenic withdrawal syndrome were found to be risk factors for developing delirium.ConclusionsBased on a validated delirium monitoring, our study gives new information regarding the prevalence of pediatric delirium and the characteristics of intensive care patients at risk for this significant complication. Especially young patients and patients after surgery for congenital heart disease seem to benefit from the implementation of non-pharmacological delirium bundles. Based on our findings, it is important to promote change in pediatric intensive care—toward a comprehensive approach to prevent delirium in critically ill children as best as possible.

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“…Delirium is often characterized by obvious cognitive dysfunction and changes in the level of consciousness as the basic clinical features [ 14 ]. Some patients may also be accompanied by abnormalities in orientation, attention, perception, and sleep cycles [ 15 ]. The prevention and early nursing care of delirium is vital to the prognosis of respiratory failure patients undergoing mechanical ventilation [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study

Wang

et al. 2022

BMC Pulm Med

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Background COPD combined with respiratory failure is very common in intensive care unit (ICU). We aimed to evaluate the current status and influencing factors of delirium in elderly COPD patients with undergoing mechanical ventilation. Methods Patients with COPD combined with respiratory failure and mechanically ventilated who were admitted to the ICU of our hospital were selected. The characteristics of included patients were assessed. Pearson correlation analysis was performed to evaluate the characteristics of patients and delirium. Logistic regression analysis was conducted to identify the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation. Results A total of 237 COPD combined with respiratory failure patients were included, the incidence of delirium was 21.94%. Pearson correlation analysis indicated that age (r = 0.784), BMI (r = 0.709), hypertension (r = 0.696), APACHE II score (r = 0.801), CPOT (r = 0.513), sedation(r = 0.626) and PaO2 (r = 0.611) were all correlated with the occurrence of delirium (all p < 0.05). Logistic regression analysis indicated that age ≥ 75y (OR 3.112, 95% CI 2.144–4.602), BMI ≤ 19 kg/m2 (OR 2.742, 95% CI 1.801–3.355), hypertension(OR 1.909, 95% CI 1.415–2.421), APACHE II score ≥ 15 (OR 2.087, 95% CI 1.724–2.615), CPOT ≥ 5 (OR 1.778, 95% CI 1.206–2.641), sedation(OR 3.147, 95% CI 2.714–3.758), PaO2 ≤ 75 mmHg(OR 2.196, 95%CI 1.875–3.088) were the risk factors of delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation (all p < 0.05). Conclusions Delirium is common in patients with COPD and respiratory failure undergoing mechanical ventilation, and there are many related influencing factors. Medical staff should pay more attention to patients with risk factors and take intervention measures as soon as possible to reduce the incidence of delirium.

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Effectiveness of Bundle Interventions on ICU Delirium: A Meta-Analysis*

Cited by 41 publications

References 38 publications

Traditional Chinese Medicine for Coronary Artery Disease Treatment: Clinical Evidence From Randomized Controlled Trials

Traditional Chinese Medicine for Coronary Artery Disease Treatment: Clinical Evidence From Randomized Controlled Trials

Implementation of a Delirium Bundle for Pediatric Intensive Care Patients

Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study

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