背景:尽管在开发和促进循证谵妄预防干预措施方面做出了广泛的努力和进展,住院患者谵妄的发生率仍然很高。证据表明,感觉刺激是预防重症患者谵妄的干预措施的核心组成部分。然而,对谵妄发生和结局的影响知之甚少.
目的:评估在外科重症监护病房(ICU)中进行感觉刺激干预对预防谵妄的效果。
方法:前瞻性,评估员-盲,平行组随机对照试验。
方法:从广州市某三甲医院外科ICU招募成年患者,中国。
方法:干预组的参与者每天接受30分钟的听觉和视觉刺激,持续一周,考虑到参与者预定义的条件和干预方案。主要结果是谵妄发生率和无谵妄天数,次要结果是谵妄持续时间,严重程度和首次发生谵妄。招募时收集了人口统计学和临床数据,使用ConfusionAssessment-ICU,每天3次,连续7天评估谵妄.
结果:一百五十二名参与者被随机分配到干预组或对照组。对于主要结果,干预组的谵妄患者少于对照组(10vs.19,风险比=0.53),虽然没有达到统计学意义。结果表明,干预组参与者的无谵妄天数长于对照组(3.66vs.2.84,p=.019)。对于次要结果,干预可显著减少谵妄持续时间(1.70±0.82vs.4.53±2.74天,p=.004)和谵妄严重程度(3.70±1.25vs.5.68±1.57,p=.002)。Kaplan-Meier曲线显示干预组较对照组明显延迟首次谵妄发生(p=.043)。
结论:该研究没有提供重要的证据来支持感觉刺激可以降低谵妄的发生率。但无谵妄天有显著差异。
结论:本研究为临床医疗服务提供者采用感官刺激方案预防谵妄提供了循证实践,显著减少谵妄持续时间和严重程度。
Despite extensive efforts and advances in developing and fostering evidence-based delirium prevention interventions, the incidence of delirium remains high in hospitalized patients. Evidence suggests that sensory stimulation is a core component in interventions to prevent delirium among critically ill patients. However, its impact on the occurrence and outcomes of delirium is poorly understood.
To evaluate the effects of a sensory stimulation intervention on preventing delirium in a surgical intensive care unit (ICU).
A prospective, assessor-blind, parallel-group randomized controlled trial. Adult patients were recruited from a surgical ICU of one tertiary hospital in Guangzhou,
China. Participants in the intervention group received a daily 30-min auditory and visual stimulation session for a week, taking into consideration the participants\' predefined condition and intervention protocol. The primary outcomes were delirium incidence and delirium-free days, and the secondary outcomes were delirium duration, severity and the first occurrence of delirium. Demographic and clinical data were collected at recruitment, and delirium was assessed three times a day for seven consecutive days using Confusion Assessment-ICU.
One hundred and fifty-two participants were randomly assigned to intervention or control groups. For primary outcomes, there were fewer patients with delirium in the intervention group than in the control group (10 vs. 19, risk ratio = 0.53), although statistical significance was not reached. The result showed that there were longer delirium-free days among participants in the intervention group than in the control group (3.66 vs. 2.84, p = .019). For secondary outcomes, the intervention could significantly reduce delirium duration (1.70 ± 0.82 vs. 4.53 ± 2.74 days, p = .004) and delirium severity (3.70 ± 1.25 vs. 5.68 ± 1.57, p = .002). The Kaplan-Meier curve showed the intervention group had a significantly delayed first occurrence of delirium compared with the control group (p = .043).
The study did not provide significant evidence to support that sensory stimulation could reduce the incidence of delirium, but significant difference on delirium-free days.
This study provides evidence-based practice for clinical healthcare providers to adopt the sensory stimulation protocol to prevent delirium, significantly reducing delirium duration and severity.