Effects of nonpharmacological interventions on sleep improvement and delirium prevention in critically ill patients: A systematic review and meta-analysis.
Study Goal
The researchers aimed to determine whether bright light therapy effectively reduces delirium in ICU patients as part of nonpharmacological interventions.
Results Summary
Bright light therapy was found to be effective in reducing delirium incidence among ICU patients, as part of a broader analysis of nonpharmacological interventions. The meta-analysis showed significant effects on delirium outcomes, though specific details on light therapy's standalone efficacy were not isolated.
Population
Critically ill patients in the intensive care unit (ICU).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Overall nonpharmacological interventions | increase | subjective sleep quality | ICU patients | standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56 | had significant effects on | #1 |
Overall nonpharmacological interventions | decrease | delirium incidence | ICU patients | odds ratio = 0.62, 95% CI = 0.53 to 0.73 | had significant effects on | #2 |
Overall nonpharmacological interventions | decrease | delirium duration | ICU patients | standardised mean difference = -0.68, 95% CI = -0.93 to -0.43 | had significant effects on | #3 |
aromatherapy | increase | sleep | ICU patients | - | effectively improved | #4 |
music | increase | sleep | ICU patients | - | effectively improved | #5 |
massage | increase | sleep | ICU patients | - | effectively improved | #6 |
exercise | decrease | delirium | ICU patients | - | effectively reduced | #7 |
family participation | decrease | delirium | ICU patients | - | effectively reduced | #8 |
information giving | decrease | delirium | ICU patients | - | effectively reduced | #9 |
cognitive stimulation | decrease | delirium | ICU patients | - | effectively reduced | #10 |
bright light therapy | decrease | delirium | ICU patients | - | effectively reduced | #11 |
architectural intervention | decrease | delirium | ICU patients | - | effectively reduced | #12 |
bundles/protocols | decrease | delirium | ICU patients | - | effectively reduced | #13 |
light/noise blocking | increase | sleep improvement and delirium prevention | ICU patients | - | ensured both | #14 |
OBJECTIVE: 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. REVIEW METHODS: 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). RESULTS: 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. CONCLUSIONS: 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. PROSPERO REFERENCE NUMBER: CRD42021230815.