Eficacia del acompañamiento familiar y de medidas ambientales para reducir la incidencia de delirio en una unidad de agudos cardiovasculares: un estudio cuasi-experimental. Reducir el delirio sin fármacos es posible, es mejor

Abstract

Introduction

The occurrence of delirium casts a shadow over the prognosis of patients, especially the critically ill. Prevention and treatment of delirium is more effective and with fewer adverse effects with multicomponent interventions than with pharmacological measures alone. The objective was to assess whether a non-pharmacological care-related intervention can reduce the incidence of delirium in an acute cardiovascular care unit.

Methods

Quasi-experimental study (before/after). ‘Before’: From November 2018 to March 2019, 190 patients aged 18 years and older, admitted to an acute cardiovascular care unit, were assessed using the Confusion Assessment Method for the ICU. From April to November 2019, a series of actions related to the physical environment and accompaniment were implemented. The ‘after’ started in November 2019 and 189 patients were assessed until early March 2020.

Results

The incidence of delirium before introducing the actions was 11,6%, which fell to 4,2% (p = 0,012) after the actions.

Discussion

Management of delirium includes effective diagnosis, delirium prevention activities and treatment, which ideally should be free of side effects.

Conclusions

The implementation of a bundle of measures related to environmental changes and involving the family, significantly reduced the incidence of delirium, to less than half.