Effectiveness of combined non-pharmacological interventions in the prevention of delirium in critically ill patients: A randomized clinical trial

Purpose: Delirium is a common dysfunction in the intensive care unit (ICU) and it is associated with negative short- and long-term outcomes. This study evaluated the effectiveness of combined non-pharmacological interventions in preventing delirium in critically ill patients.

Materials and methods: This is a single-center randomized controlled trial conducted in three Brazilian ICUs from February to September 2019. Patients assigned to the control group received standard care (n = 72) and those assigned to the experimental group (n = 72) received a bundle of non-pharmacological interventions (periodic reorientation, cognitive stimulation, correction of sensory deficits [visual or hearing impairment], environmental management and sleep promotion) throughout the ICU stay. Delirium was monitored twice a day with the Confusion Assessment Method for the Intensive Care Unit Flowsheet. The primary outcome was the incidence density of delirium.

Results: The incidence density of delirium was lower in the intervention group (1.3 × 10^-2 person-days) than in the control group (2.3 × 10^-2 person-days), with a hazard ratio of 0.40 (95% confidence intervals, 0.17-0.95; p = 0.04) after adjustment for Simplified Acute Physiology Score III, surgical admission and alcoholism.

Conclusions: Combined non-pharmacological interventions reduced delirium in critically ill patients, compared to standard care.

Trial registration: Brazilian Registry of Clinical Trials (ReBEC), Identifier RBR-6xq95s, October 03, 2018.