CALM ICU guidelines: Preliminary guidelines on non-pharmacological strategies for agitation in the ICU − A Delphi study

Aim

To develop preliminary clinical practice guidelines for the non-pharmacological prevention and management of patient agitation in the intensive care unit.

Methods

A modified three-round Delphi study was conducted between January and May 2022 and involved 114 participants from Denmark and Australia, including clinicians, researchers, patients, and family members. The first Delphi round was built on a systematic review of non-pharmacological interventions for managing agitation, a modified umbrella review encompassing qualitative reviews on patient experiences in the intensive care unit and guidelines for managing agitation across all health care settings along with stakeholder consultation. Recommendations were included if they reached a consensus level (IQR ≥ 1) of 75 % or higher in both Denmark and Australia.

Results

A total of 63 recommendations for preventing and managing patient agitation in the ICU were included in the preliminary guidelines. The recommendations were grouped into nine themes, forming a new model of care. The themes include care principles, assessment of agitation, identification and treatment of causes of agitation, caregiver behaviours and developing trusting relationships, family involvement, psychosocial needs, physical needs, individualised care and interventions related to the context. Differences in consensus were noted between the two countries and between stakeholders.

Conclusions

The study provides robust evidence for preliminary guidelines for the non-pharmacological prevention and management of patient agitation in the ICU. The guidelines emphasise the importance of developing trusting relationships, addressing individual patient needs and ensuring organisational support for successful implementation. The guidelines are preliminary and will be tailored to each country, graded and undergo public consultation and expert methodological reviews.

Implications for Clinical Practice

In the absence of established clinical guidelines, these preliminary guidelines offer a framework for ICU clinicians to manage patient agitation effectively, prioritising non-pharmacological approaches and minimising the use of physical and chemical restraints. The findings highlight the need for further research on non-pharmacological strategies to manage agitation.