Deliryumun Önlenmesinde Çok Bileşenli Farmakolojik Olmayan Hemşirelik Müdahaleleri

Year 2022, Volume: 3 Issue: 1, 71 - 80, 09.06.2022

Gülşen Kılıç , Sultan Kav

Abstract

Deliryum ani başlangıçlı, gün içerisinde dalgalanan bir dikkat seyri ve düşünce ve/veya davranış değişiklikleri ile karakterize bir durumdur. Altta yatan tıbbi durumla ilişkili olmakla birlikte yoğun bakım ünitelerinde yatan hastalarda sıklıkla görülmektedir. Yoğun bakımdaki hastada deliryumun ortaya çıkması hastanede kalış süresini, tedavi maliyetlerini olumsuz etkilemekte, hastanın bilişsel ve fonksiyonel işlevselliğini azaltmakta ve mortalite insidansını arttırmaktadır. Yoğun bakım ünitelerine bakım ve tedavi amacı ile kabul edilen hastada çok boyutlu bir değerlendirme yapan hemşireler, deliryum gelişiminde etkisi olan risk faktörlerinin iyileştirilmesinde kanıta dayalı en uygun girişimi planlama, uygulama ve değerlendirmede önemli bir yere sahiptir. Hastalarda deliryum gelişimiyle ilişkisi olduğu düşünülen birçok faktörün, çok bileşenli hemşirelik müdahaleleri ile deliryum insidansını ve deliryuma bağlı olumsuz sonuçları azaltılabileceği gösterilmiştir. Bu derlemede deliryumun önlenmesi ve yönetiminde kullanılan çok bileşenli farmakolojik olmayan müdahalelerin literatürde yer alan güncel bilgiler doğrultusunda tartışılması amaçlanmıştır.

Keywords

Çok bileşenli farmakolojik olmayan yöntemler, deliryum, hemşirelik

Multicomponent Non-Pharmacological Nursing Interventions for Prevention of Delirium

Abstract

Delirium is an acute -onset disorder with fluctuating course of attention and changes in thought and/or behavior throughout the day. Although it is associated with the underlying medical condition, it is frequently seen in patients hospitalized in intensive care units. Development of delirium in the patient in the intensive care unit; it negatively affects the length of hospital stay, treatment costs, decreases the cognitive and functional functionality of the patient and increases the incidence of mortality. Nurses, who make a multidimensional evaluation of the patient admitted to the intensive care units for care and treatment, have an important place in planning, applying and evaluating the most appropriate evidence-based intervention in the improvement of risk factors that have an effect on the development of delirium. It shows that many factors that are thought to be related to the development of delirium in patients can be reduced with multi-component nursing interventions, and the incidence of delirium and negative outcomes related to delirium can be reduced. In this review, it is aimed to discuss multi-component non-pharmacological interventions used in the prevention and management of delirium in line with the current information in the literature.

Keywords

delirium, multi-component non-pharmacologic strategy, nursing

References

• 1. Reznik ME, Slooter AJC. Delirium management in the ICU. Curr Treat Options Neurol. 2019;21(11):59. doi: 10.1007/s11940-019-0599-5.
• 2. Hargrave A, et al. Validation of a nurse-based delirium-screening tool for hospitalized patients. Psychosomatics. 2017;58(6):594-603. doi: 10.1016/j.psym.2017.05.005
• 3. Society of Critical Care Medicine (SCCM). PADIS-Guidelines-Teaching-Slides-Delirium. [Internet]. 2018. [Erişim Tarihi: 02.06.2021]. https://www.sccm.org/ICULiberation/ABCDEF-Bundles
• 4. Fan Y, Guo Y, Li Q, Zhu X. A review: Nursing of intensive care unit delirium. J Neurosci Nurs. 2012;44(6):307-16. doi: 10.1097/JNN.0b013e3182682f7f.
• 5. Bilge Ü, Kaya M, Şenel G, Ünver S. Erişkin hastalarda postoperatif yoğun bakım ünitesinde deliryum insidansı. Turk J Anaesth Reanim. 2015;43:232-9.
• 6. Fricchione GL, et al. Postoperative delirium. Am J Psychiatry. 2008;165:803-12. doi: 10.1176/appi.ajp.2008.08020181.
• 7. Brouquet A, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251:759-65. doi: 10.1097/SLA.0b013e3181c1cfc9.
• 8. Sanders RD, Pandharipande PP, Davidson AJ, Ma D, Maze M. Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ. 2011:20;343:d4331. doi: 10.1136/bmj.d4331.
• 9. Irwın, SA, Pırrello RD, Hırst JM, Buckholz GT, Ferrıs FD. Clarifying delirium management: Practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med. 2013;16(4): 423-435. doi: 10.1089/jpm.2012.0319.
• 10. Yaşayacak A, Eker F. Kalp damar cerrahisi yoğun bakim ünitesinde yatan hastalarda deliryum ve risk faktörlerinin belirlenmesi. TGKDC dergisi. 2012;20(2):265-274.
• 11. Devlin JW, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, ımmobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):825-873. doi: 10.1097/CCM.0000000000003299.
• 12. Baron R, Binder A, Biniek R, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015)- short version. Ger Med Sci. 2015;13:1-42. doi: 10.3205/000223
• 13. Salluh JI, Wang H, Schneider EB, et al. Outcome of delirium in critically ill patients: Systematic review and meta-analysis. BMJ. 2015;350:2538. doi: 10.1136/bmj.h2538.
• 14. Karadaş C, Özdemir L. Deliryumun yönetiminde farmakolojik olmayan yaklaşımlar ve hemşirenin sorumlulukları. J Psychiatric Nurs. 2019;10(2):137-142.
• 15. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit: executive summary. Am J Health Syst Pharm. 2013;70(1):53-8. doi: 10.1093/ajhp/70.1.53.
• 16. Bölükbaş PR. Yoğun bakım ünitelerindeki yaşlı hastalarda deliryumun değerlendirilmesi, önlenmesi ve yönetimine ilişkin stratejiler. Yoğun Bakım Hemşireliği Dergisi. 2015;19(2):68-79.
• 17. Marra A, Frimpong K, Ely EW. The ABCDEF implementation bundle. Korean J Crit Care Med. 2016;31(3):181-193. doi: 10.4266/kjccm.2016.00682
• 18. Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin. 2017;33(2):225-243. doi:10.1016/j.ccc.2016.12.005
• 19. Morandi A, Piva S, Ely EW, et al. Worldwide survey of the "assessing pain, both spontaneous awakening and breathing trials, choice of drugs, delirium monitoring/management, early exercise/mobility, and family empowerment" (ABCDEF) bundle. Crit Care Med. 2017;45(11):1111-1122. doi: 10.1097/CCM.0000000000002640.
• 20. Moraes FDS, Marengo LL, Silva MT, et al. ABCDE and ABCDEF care bundles: A systematic review protocol of the implementation process in intensive care units. Medicine (Baltimore). 2019;98(11):14792 doi: 10.1097/MD.0000000000014792.
• 21. Pun BT, et al. Caring for critically ıll patients with the ABCDEF bundle: Results of the ıcu liberation collaborative in over 15,000 adults. Crit Care Med. 2019;47(1):3-14. doi: 10.1097/CCM.0000000000003482.
• 22. Barnes-Daly MA, Phillips G, Ely EW. Improving hospital survival and reducing brain dysfunction at seven california community hospitals: Implementing PAD guidelines Via the ABCDEF bundle in 6,064 patients. Crit Care Med. 2017;45(2):171-178. doi: 10.1097/CCM.0000000000002149.
• 23. Guthrie PF, Rayborn S, Butcher H. Evidence-based practice guideline: delirium. J Gerontol Nurs 2018;44(2):14-24. doi: 10.3928/00989134-20180110-04
• 24. Bennett C. Caring for patients with delirium. Nursing. 2019;49(9):17-20. doi: 10.1097/01.nurse.0000577772.92256.8a
• 25. Hshieh TT, Yue J, Oh E, et al. Effectiveness of multi-component non-pharmacologic delirium interventions: a meta-analysis. JAMA Intern Med. 2015;175(4):512–520.
• 26. Fraser D, Spiva L, Forman W, Hallen C. Original research: implementation of an early mobility program in an icu. Am J Nurs. 2015;115(12):49-58. doi: 10.1001/jamainternmed.2014.7779.
• 27. Park SY, Lee HB. Prevention and management of delirium in critically ill adult patients in the intensive care unit: a review based on the 2018 PADIS guidelines. Acute Crit Care. 2019;34(2):117-125. doi: 10.4266/acc.2019.00451.
• 28. Liang S, Chau JPC, Lo SHS, Zhao J, Choi KC. Effects of nonpharmacological delirium-prevention interventions on critically ill patients' clinical, psychological, and family outcomes: a systematic review and meta-analysis. Aust Crit Care. 2021;34(4):378-387. doi: 10.1016/j.aucc.2020.10.004.
• 29. Burton JK, et al. Non‐pharmacological interventions for preventing delirium in hospitalised non‐ICU patients. Cochrane Database of Syst Rev. 2021;11(11):CD013307. doi: 10.1002/14651858.CD013307.pub2.
• 30. Rivosecchi RM, Kane-Gill SL, Svec S, Campbell S, Smithburger PL. The implementation of a nonpharmacologic protocol to prevent intensive care delirium. J Crit Care. 2016;31(1):206-11. doi: 10.1016/j.jcrc.2015.09.031.
• 31. Álvarez EA, Garrido MA, Tobar EA et al. Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. J Crit Care. 2017;37:85-90. doi: 10.1016/j.jcrc.2016.09.002.
• 32. Ludolph P, Stoffers-Winterling J, Kunzler AM, et al. Non-pharmacologic multicomponent interventions preventing delirium in hospitalized people. J Am Geriatr Soc. 2020;68(8):1864-1871. doi: 10.1111/jgs.16565. 33. Guo Y, Sun L, Li L,et al. Impact of multicomponent, nonpharmacologic interventions on perioperative cortisol and melatonin levels and postoperative delirium in elderly oral cancer patients. Arch Gerontol Geriatr. 2016;62:112-7. doi: 10.1016/j.archger.2015.10.009. 34. Moon KJ, Lee SM. The effects of a tailored intensive care unit delirium prevention protocol: a randomized controlled trial. Int J Nurs Stud. 2015;52(9):1423-32. doi: 10.1016/j.ijnurstu.2015.04.021.