Impact of Pain, Agitation, and Delirium Bundle on Delirium and Cognitive Function

Xiao-Ping WANG; Dan LV; Yun-Fang CHEN; Na CHEN; Xiao-Dong LI; Cheng-Fei XU; Yin LI; Li TIAN

doi:10.1097/jnr.0000000000000497

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Impact of Pain, Agitation, and Delirium Bundle on Delirium and Cognitive Function

Xiao-Ping WANG ； Dan LV ； Yun-Fang CHEN ； Na CHEN ； Xiao-Dong LI ； Cheng-Fei XU ； Yin LI ； Li TIAN

The Journal of Nursing Research ； 30 卷 4 期 (2022 / 08 / 01) ， P1 - 9

英文 DOI： 10.1097/jnr.0000000000000497

delirium ； cognition ； patient care bundles ； mechanical ventilation ； intensive care units

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摘要 │ 参考文献 (25) │ 国际计量

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Background: Differences in short-term cognitive function between mechanically ventilated patients treated with multi-component interventions and those receiving routine nursing care have not been established because of the lack of follow-up in previous studies. Purpose: This study was designed to evaluate the effects of the pain, agitation, and delirium (PAD) care bundle on delirium occurrence and clinical outcomes, specifically in terms of short-term cognitive function, in mechanically ventilated patients. Methods: Data on 243 patients with mechanical ventilation were analyzed from January 2017 to February 2019. The eligible patients were divided randomly into two groups. The control group (n = 120) received usual care, whereas the intervention group (n = 123) received the PAD bundle, including pain monitoring and management, light sedation and daily awakening, early mobility, sleep promotion, and delirium monitoring. The incidence and duration of delirium, ventilator time, and intensive care unit (ICU) length of stay were compared between the two groups. Upon discharge from the ICU and at 3 and 6 months after discharge, cognitive function was assessed using the Montreal Cognitive Assessment scale and compared between the two groups. Results: The incidence of delirium was reduced significantly in the intervention group, and significant decreases in the duration of delirium, ventilator time, and ICU length of stay were found. Cognitive impairment in the intervention group was significantly lower at the 3-month follow-up assessment. Conclusions/Implications for Practice: The PAD bundle was shown to be associated with a lower incidence of delirium and improved clinical outcomes. Short-term cognitive impairment occurred in fewer patients who were managed with the PAD bundle after ICU discharge. Our findings indicate that the PAD bundle has the potential to improve clinical outcomes. The administrative staff of ICUs should use strategies, such as interdisciplinary teamwork, to facilitate the buy-in and implementation of interventions.

参考文献 ( 25 ) 〈TOP〉

Álvarez, E. A.,Garrido, M. A.,Tobar, E. A.,Prieto, S. A.,Vergara, S. O.,Briceño, C. D.,González, F. J.(2017).Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit, a pilot randomized clinical trial.Journal of Critical Care,37,85-90.
American Psychiatric Association(2013).Diagnostic and statistical manual of mental disorders.Author.
Balas, M. C.,Vasilevskis, E. E.,Olsen, K. M.,Schmid, K. K.,Shostrom, V.,Cohen, M. Z.,Peitz, G.,Gannon, D. E.,Sisson, J.,Sullivan, J.,Stothert, J. C.,Lazure, J.,Nuss, S. L.,Jawa, R. S.,Freihaut, F.,Ely, E. W.,Burke, W. J.(2014).Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle.Critical Care Medicine,42(5),1024-1036.
Barr, J.,Fraser, G. L.,Puntillo, K.,Ely, E. W.,Gelinas, C.,Dasta, J. F.,Davidson, J. E.,Devlin, J. W.,Kress, J. P.,Joffe, A. M.,Coursin, D. B.,Herr, D. L.,Tung, A.,Robinson, B. R.,Fontaine, D. K.,Ramsay, M. A.,Riker, R. R.,Sessler, C. N.,Pun, B.,Jaeschke, R.(2013).Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.Critical Care Medicine,41(1),263-306.
Brummel, N. E.,Jackson, J. C.,Pandharipande, P. P.,Thompson, J. L.,Shintani, A. K.,Dittus, R. S.,Gill, T. M.,Bernard, G. R.,Ely, E. W.,Girard, T. D.(2014).Delirium in the ICU and subsequent long-term disability among survivors of mechanical ventilation.Critical Care Medicine,42,369-377.

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