Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis
Sleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the non...
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| Veröffentlicht in: | Australian critical care 2023-07, Vol.36 (4), p.640-649 |
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| creator | Kang, Jiyeon Cho, Young Shin Lee, Minju Yun, Seonyoung Jeong, Yeon Jin Won, Youn-Hui Hong, Jiwon Kim, Soogyeong |
| description | Sleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the nonpharmacological interventions provided to improve sleep or prevent delirium in ICU patients or both and integrate their effect sizes.
This study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).
The systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = −0.68, 95% CI = −0.93 to −0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention.
Our results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person–environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium.
CRD42021230815 |
| doi_str_mv | 10.1016/j.aucc.2022.04.006 |
| format | Article |
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This study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).
The systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = −0.68, 95% CI = −0.93 to −0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention.
Our results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person–environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium.
CRD42021230815</description><identifier>ISSN: 1036-7314</identifier><identifier>EISSN: 1878-1721</identifier><identifier>DOI: 10.1016/j.aucc.2022.04.006</identifier><identifier>PMID: 35718628</identifier><language>eng</language><publisher>Australia: Elsevier Ltd</publisher><subject>Critical Care ; Critical care nursing ; Critical Illness - psychology ; Delirium ; Delirium - prevention & control ; Humans ; Intensive Care Units ; Meta-analysis ; Sleep ; Systematic review</subject><ispartof>Australian critical care, 2023-07, Vol.36 (4), p.640-649</ispartof><rights>2022 Australian College of Critical Care Nurses Ltd</rights><rights>Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-193e9afdae665c2ea2979bf64e9b079678783df6131f0e6a4ee225ed176c79cc3</citedby><cites>FETCH-LOGICAL-c356t-193e9afdae665c2ea2979bf64e9b079678783df6131f0e6a4ee225ed176c79cc3</cites><orcidid>0000-0001-8432-0420 ; 0000-0002-0015-921X ; 0000-0003-4691-0512</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1036731422000625$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35718628$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Jiyeon</creatorcontrib><creatorcontrib>Cho, Young Shin</creatorcontrib><creatorcontrib>Lee, Minju</creatorcontrib><creatorcontrib>Yun, Seonyoung</creatorcontrib><creatorcontrib>Jeong, Yeon Jin</creatorcontrib><creatorcontrib>Won, Youn-Hui</creatorcontrib><creatorcontrib>Hong, Jiwon</creatorcontrib><creatorcontrib>Kim, Soogyeong</creatorcontrib><title>Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis</title><title>Australian critical care</title><addtitle>Aust Crit Care</addtitle><description>Sleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the nonpharmacological interventions provided to improve sleep or prevent delirium in ICU patients or both and integrate their effect sizes.
This study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).
The systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = −0.68, 95% CI = −0.93 to −0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention.
Our results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person–environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium.
CRD42021230815</description><subject>Critical Care</subject><subject>Critical care nursing</subject><subject>Critical Illness - psychology</subject><subject>Delirium</subject><subject>Delirium - prevention & control</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Meta-analysis</subject><subject>Sleep</subject><subject>Systematic review</subject><issn>1036-7314</issn><issn>1878-1721</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO1DAQRS0EYh7wAyyQl2wS_EjbCWIzGg0M0khsYG25nTK45UewnUH9K3wtDt2wZOWS694j1b0IvaKkp4SKt4der8b0jDDWk6EnRDxBl3SUY0clo0_bTLjoJKfDBboq5UAImwYxPEcXfCfpKNh4iX7dWQumFpwsjiku33UO2iSfvjmjPXaxQn6EWF2KTRNx8QALdmHJ6RFCW2AdZzyDd9mtAS8ZzupmxSa7umH8ETvv8aKra8vyDt_gciwVQvswuFkc_PzDCVB1p6P2x-LKC_TMal_g5fm9Rl8_3H25ve8ePn_8dHvz0Bm-E7WjE4dJ21mDEDvDQLNJTnsrBpj2RE5CtkD4bAXl1BIQegBgbAczlcLIyRh-jd6cuO2mHyuUqoIrBrzXEdJaFNsQA2cjbVJ2kpqcSslg1ZJd0PmoKFFbJ-qgtk7U1okig2qdNNPrM3_dB5j_Wf6W0ATvTwJoV7YssiqmBWVgdrl1o-bk_sf_DQZUogU</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Kang, Jiyeon</creator><creator>Cho, Young Shin</creator><creator>Lee, Minju</creator><creator>Yun, Seonyoung</creator><creator>Jeong, Yeon Jin</creator><creator>Won, Youn-Hui</creator><creator>Hong, Jiwon</creator><creator>Kim, Soogyeong</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8432-0420</orcidid><orcidid>https://orcid.org/0000-0002-0015-921X</orcidid><orcidid>https://orcid.org/0000-0003-4691-0512</orcidid></search><sort><creationdate>202307</creationdate><title>Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis</title><author>Kang, Jiyeon ; Cho, Young Shin ; Lee, Minju ; Yun, Seonyoung ; Jeong, Yeon Jin ; Won, Youn-Hui ; Hong, Jiwon ; Kim, Soogyeong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-193e9afdae665c2ea2979bf64e9b079678783df6131f0e6a4ee225ed176c79cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Critical Care</topic><topic>Critical care nursing</topic><topic>Critical Illness - psychology</topic><topic>Delirium</topic><topic>Delirium - prevention & control</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Meta-analysis</topic><topic>Sleep</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Jiyeon</creatorcontrib><creatorcontrib>Cho, Young Shin</creatorcontrib><creatorcontrib>Lee, Minju</creatorcontrib><creatorcontrib>Yun, Seonyoung</creatorcontrib><creatorcontrib>Jeong, Yeon Jin</creatorcontrib><creatorcontrib>Won, Youn-Hui</creatorcontrib><creatorcontrib>Hong, Jiwon</creatorcontrib><creatorcontrib>Kim, Soogyeong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Australian critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Jiyeon</au><au>Cho, Young Shin</au><au>Lee, Minju</au><au>Yun, Seonyoung</au><au>Jeong, Yeon Jin</au><au>Won, Youn-Hui</au><au>Hong, Jiwon</au><au>Kim, Soogyeong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis</atitle><jtitle>Australian critical care</jtitle><addtitle>Aust Crit Care</addtitle><date>2023-07</date><risdate>2023</risdate><volume>36</volume><issue>4</issue><spage>640</spage><epage>649</epage><pages>640-649</pages><issn>1036-7314</issn><eissn>1878-1721</eissn><abstract>Sleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the nonpharmacological interventions provided to improve sleep or prevent delirium in ICU patients or both and integrate their effect sizes.
This study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).
The systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = −0.68, 95% CI = −0.93 to −0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention.
Our results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person–environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium.
CRD42021230815</abstract><cop>Australia</cop><pub>Elsevier Ltd</pub><pmid>35718628</pmid><doi>10.1016/j.aucc.2022.04.006</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8432-0420</orcidid><orcidid>https://orcid.org/0000-0002-0015-921X</orcidid><orcidid>https://orcid.org/0000-0003-4691-0512</orcidid></addata></record> |
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| ispartof | Australian critical care, 2023-07, Vol.36 (4), p.640-649 |
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| subjects | Critical Care Critical care nursing Critical Illness - psychology Delirium Delirium - prevention & control Humans Intensive Care Units Meta-analysis Sleep Systematic review |
| title | Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis |
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