背景:谵妄是行为的急性变化,以波动的过程为特征,注意力不集中,和杂乱无章的思维。对于重症监护中的危重成年人,据报道,谵妄的发生率至少为30%,并且与短期和长期并发症有关。住院时间更长,死亡风险增加,和长期的认知问题。
目的:本研究的目的是确定护士主导的谵妄预防方案在降低重症监护成人谵妄发生率和持续时间方面的有效性。
方法:进行了一项混合阶梯式楔形整群随机对照试验,以评估护士主导的干预措施的实施和传播的有效性,以减少成人的谵妄发生率和持续时间在悉尼西南部的四个成人重症监护病房。澳大利亚。
结果:从2019年5月到2020年2月,在10个月的时间里,2618招生,在2566名患者中,包括在研究中。在最初的3个月基线期之后,每个月,在四个重症监护病房之一中,护士主导的干预措施都会随机交叉,到审判的第七个月,所有单位接受干预至少3个月.急性谵妄的发生率为10.7%(95%置信区间[CI]=9.1-12.4%),与干预前(基线)期间的14.1%(95%CI=12.2-16.2%)相比(调整后的比率[adjRR]=0.78,95%CI=0.57-1.08,p=0.134).干预前和干预后的平均无谵妄天数分别为4.1天(95%CI=3.9-4.3)和4.4天(95%CI=4.2-4.5),分别(调整后的差异=0.24天[95%CI=-0.12至0.60],p=0.199)。
结论:在引入护士领导后,非药物干预,以减轻谵妄的负担,在接受重症监护的成年人中,我们观察到谵妄发生率或谵妄持续时间无统计学显著下降.
BACKGROUND: Delirium is an acute change in behaviour, characterised by a fluctuating course, inattention, and disorganised thinking. For critically ill adults in the intensive care, the incidence of delirium has been reported to be at least 30% and is associated with both short-term and long-term complications, longer hospital stay, increased risk of mortality, and long-term cognitive problems.
OBJECTIVE: The objective of this study was to determine the effectiveness of a nurse-led delirium-prevention protocol in reducing the incidence and duration of delirium among adults admitted to intensive care.
METHODS: A hybrid stepped-wedge cluster randomised controlled trial was conducted to assess the effectiveness of the implementation and dissemination of the nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adults intensive care units in the southwest of Sydney, Australia.
RESULTS: Between May 2019 and February 2020, over a 10-month period, 2618 admissions, among 2566 patients, were included in the study. After an initial 3-month baseline period, each month there was a random crossover to the nurse-led intervention in one of the four intensive care units, and by the 7th month of the trial, all units were exposed to the intervention for at least 3 months. The incidence of acute delirium was observed to be 10.7% (95% confidence interval [CI] = 9.1-12.4%), compared to 14.1% (95% CI = 12.2-16.2%) during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78, 95% CI = 0.57-1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention periods were 4.1 days (95% CI = 3.9-4.3) and 4.4 days (95% CI = 4.2-4.5), respectively (adjusted difference = 0.24 days [95% CI = -0.12 to 0.60], p = 0.199).
CONCLUSIONS: Following the introduction of a nurse-led, nonpharmacological intervention to reduce the burden of delirium, among adults admitted to intensive care, we observed no statistically significant decrease in the incidence of delirium or the duration of delirium.