Mobilization in the evening to prevent delirium: a pilot randomized trial.
Author
Nydahl, PeterMcWilliams, David
Weiler, Norbert
Borzikowsky, Christoph
Howroyd, Fiona
Brobeil, Angelika
Lindner, Matthias
von Haken, Rebecca
Publication date
2021-05-04
Metadata
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Background: Delirium is a common complication in patients in Intensive Care Units (ICU). Interventions such as mobilization are effective in the prevention and treatment of delirium, although this is usually completed during the daytime. Aim: The aim of this study was to assess the feasibility of mobilization in the evening to prevent and treat ICU patients from delirium by an additional mobility team over 2 weeks. Methods: The design was a pilot, multi-centre, randomized, controlled trial in four mixed ICUs over a period of 2 weeks. The mobility team consisted of trained nurses and physiotherapists. Patients in the intervention group were mobilized onto the edge of the bed or more between 21.00 and 23.00. Patients in the control group received usual care. The primary outcome parameter was the feasibility of the study, measured as recruitment rate, delivery rate, and safety. Secondary outcomes were duration and incidence of delirium, mortality, duration of mechanical ventilation (MV), and hospital length of stay for 28 days follow-up, and power calculation for a full trial. Results: Out of 185 patients present in the ICUs, 28.6% (n = 53) were eligible and could be recruited, of which 24.9% (n = 46, Intervention = 26, Control = 20) were included in the final analysis. In the intervention group, mobilization could be delivered in 75% (n = 54) of 72 possible occasions; mobilization-related safety events appeared in 16.7% (n = 9) without serious consequences. Secondary parameters were similar, with less delirium in the intervention group albeit not significant. With an association of Cramer's V = 0.237, a complete study reaching statistical significance would require at least 140 patients, last 6 weeks, and cost >30 000 €. Conclusions: In a mixed ICU population, mobilization in the evening was feasible in one-quarter of patients with a low rate of safety events. Future trials seem to be feasible and worth conducting.Citation
Nydahl P, McWilliams D, Weiler N, Borzikowsky C, Howroyd F, Brobeil A, Lindner M, von Haken R. Mobilization in the evening to prevent delirium: A pilot randomized trial. Nurs Crit Care. 2022 Jul;27(4):519-527. doi: 10.1111/nicc.12638. Epub 2021 May 4Type
ArticleAdditional Links
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1478-5153PMID
33946128Journal
Nursing in Critical CarePublisher
Wileyae974a485f413a2113503eed53cd6c53
10.1111/nicc.12638