Effectiveness of non-pharmacological intervention protocol for prevention of postoperative delirium in the surgical intensive care unit

Jan 20, 2025Scientific reports

How well non-drug methods prevent delirium after surgery in intensive care

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Abstract

The incidence of postoperative delirium (POD) was 40.0% in the pre-intervention period and 38.0% in the intervention period.

No significant difference in POD incidence was observed between the pre-intervention and intervention periods (P = 0.723).
The multicomponent non-pharmacological intervention protocol was not associated with a reduction in POD prevention (OR 0.70 for Model 1; OR 0.63 for Model 2).
The intervention protocol was linked to a lower incidence of specific SICU events, including self-removal of the endotracheal tube and nosocomial infection.
The study involved 300 patients aged ≥ 65 years admitted to the surgical ICU within 7 days postoperatively.

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Postoperative delirium (POD) is a common adverse event in patients admitted to the intensive care unit (ICU). We aimed to determine the effectiveness of a multicomponent non-pharmacological intervention protocol to reduce the incidence of POD in elderly patients admitted to the surgical ICU (SICU). This before-and-after cohort study included 300 patients aged ≥ 65 years who were admitted to the SICU within 7 days postoperatively with an anticipated SICU stay > 24 h. During the pre-intervention period, patients received medical care based on the attending physicians. While during the intervention, patients received the same medical care plus a multicomponent non-pharmacological intervention protocol. POD was monitored twice daily using the Confusion Assessment Method for the ICU. Demographic and clinical data during SICU stay were collected and compared between the pre-intervention and intervention periods. The primary outcome was POD incidence. The secondary outcomes were POD duration, delirium-free days, and other clinical outcomes. The incidences of POD during the pre-intervention and intervention periods were not different (40.0% vs. 38.0%, P = 0.723; OR 0.92, 95% CI 0.58-1.46). Multivariate regression analyses with two different models demonstrated that the multicomponent non-pharmacological intervention protocol was not associated with POD prevention (OR 0.70, 95% CI 0.39-1.25 for Model 1 and OR 0.63, 95% CI 0.37-1.08 for Model 2). The protocol was associated with lower incidence of SICU events, particularly self-removal of endotracheal tube and nosocomial infection. Implementation of the multicomponent non-pharmacological intervention protocol was not associated with POD prevention in elderly patients admitted to the SICU.Trial registration Thai Clinical Trials Registry. Trial No. TCTR20181201001. Retrospective registered 01 December 2018.

Key numbers

40.0%

POD Incidence

POD incidence in pre-intervention cohort

38.0%

POD Incidence

POD incidence in intervention cohort

16.5 days

Shorter Hospital Stay

Median hospital length of stay in intervention cohort

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Effectiveness of non-pharmacological intervention protocol for prevention of postoperative delirium in the surgical intensive care unit

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