Mobilization in the evening to prevent delirium: A pilot randomized trial

Peter Nydahl, David McWilliams, Norbert Weiler, Christoph Borzikowsky, Fiona Howroyd, Angelika Brobeil, Matthias Lindner, Rebecca von Haken

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    Abstract

    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.

    Original languageEnglish
    Pages (from-to)519-527
    Number of pages9
    JournalNursing in Critical Care
    Volume27
    Issue number4
    Early online date4 May 2021
    DOIs
    Publication statusPublished - Jul 2022

    Bibliographical note

    This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

    Funder

    Funding Information: We are thankful for the German Society of Critical Care Medicine and Co. Philips, which financed the pilot study. This work is funded by the Delirium Research Prize of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the Philips company.

    Keywords

    • delirium
    • early mobilization
    • intensive care unit
    • prevention
    • rehabilitation

    ASJC Scopus subject areas

    • Critical Care

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