NURSING INTERVENTIONS IN MANAGEMENT OF COVID-19-RELATED DELIRIUM IN INTENSIVE CARE UNITS: LITERATURE REVIEW

Year 2021, , 128 - 143, 28.04.2021

Emine Kaplan Serin , Semra Bülbüloğlu

https://doi.org/10.33457/ijhsrp.845184

Abstract

Development of delirium is highly probable in Covid-19 patients and its management is much more difficult than in other diseases. Nurses have important roles in delirium management that may develop in covid-19 patients. The aim of this paper was to review the literature regarding non-pharmacological interventions in intensive care units (ICUs) to prevent the delirium in Covid-19 patients. A literture review was used. The terms used in the literature search were ‘intensive care’ or ‘critical care’ including their abbreviations, as well as ‘delirium,’ ‘intervention,’ ‘approach,’ ‘nursing’ or ‘non-pharmacologic’ or ‘treat’ or ‘management’ or ‘prevention’ and ‘Covid-19’ with Turkish and English words. Literature was scanned using keywords based on the Medical Subjects Headings (MeSH) and Embase Tree (EMTREE) from the databases of Cochrane, CINAHL, PsyInfo, PubMed, and EMBASE.A total of 63 studies were included in the review. In this paper, it was found that non-pharmacological interventions had an important place in delirium management; however, the transmission way of Covid-19 via droplets prevents many non-pharmacological attempts. First and fore-most among these interventions is the termination of the sedating drug, preventing isolation, ensuring that the patient spends time with visitors, and weaning from mechanical ventilation. Covid-19 patients, latest technology can be used for help prevent social isolation. Based on the findings of this literature review, we recommend a patient-centered approach in the management of delirium in Covid-19 patients and a revision of current strategies in accordance with the profiles of the patient and the disease. To raise awareness in interventions for delirium syndrome that may cause in covid 19 disease for nurses.

Keywords

Covid-19, Intensive Care Unit, Delirium, Non-pharmacological, Prevention, Literature Review

References

• [1] LaHue, S.C., et al.,‘’Collaborative Delirium Prevention in the Age of COVID‐19’’ Journal of the American Geriatrics Society, 2020.
• [2] Wu, Z., McGoogan, J.M., ‘’Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention’’, JAMA, 2020.
• [3] World Health Organization, ‘’Protocol for assessment of potential risk factors for coronavirus disease 2019 (COVID-19) among health workers in a health care setting, 2020’’, Retrieved from No. WHO/2019-nCoV/HCW_risk_factors_protocol/2020.3 (accessed 23/03/2020).
• [4] Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, ‘’Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)-China, 2020’’, China CDC Weekly, 2020, Retrieved from http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e99a9b-fea8db1a8f51 (accessed 20/05/2020)
• [5] Battegay, M., et al., ‘’2019-Novel coronavirus (2019-nCoV): estimating the case fatality rate: aword of caution’’, SwissMedWkly, 150, 2020. w20203.doi:10.4414/smw.2020.20203
• [6] Dı̇lek, F., et al., ‘’Most Seen Problems ans Nursing Care in Geriatric Patients Receiving Intensive Care Treatment: Review’’, Intensive Care J Nurs, 9(1), 29-35, 2015.
• [7] Karadaş, C., ‘’Non-Pharmacological Approaches and Nursing Responsibilities in Delirium Management’’, J Psychiatr Nurs, Retrieved from: https://www.journalagent.com/phd/pdfs/PHD-81994-REVIEW-KARADAS.pdf (accessed 1/5/2020)
• [8] Kang, J., et al., ‘’Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: A systematic review and meta-analysis’’, J Crit Care, 48, 372–84, 2018.
• [9] Morandi, A., et al., ‘’Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients’’, Intensive Care Med, 34(10), 1907-15, 2008.
• [10] Spronk, P.E., et al., ‘’Occurrence of delirium is severely underestimated in the ICU during daily care’’ Intensive Care Med, 35(7), 1276-80, 2009.
• [11] Bounds, M., et al., ‘’Effect of ABCDE bundle implementation on prevalence of delirium in intensive care unit patients’’, Am J Crit Care, 25(6), 535-44,2016.
• [12] Özdemı̇r, L., ‘’The Management of Delirium in Intensive Care Patients and the Responsibilities of Nurses’’, Hacettepe University J Nurs, 1(1), 90-8, 2015.
• [13] NICE Guidance Delirium: prevention, diagnosis and management, Retrieved from: https://www.nice.org.uk/guidance/cg103/chapter/1-Guidance#treating-delirium (accessed 2/5/2020)
• [14] American Psychiatric Association, ‘’Diagnostic and Statistical Manual of Mental Disorders’’ 5th ed. Arlington, VA, American Psychiatric Publishing, 2013.
• [15] Hshieh, T.T., et al. ‘’Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis,’’ JAMA Intern Med, 175(4), 512-20, 2015.
• [16] Stuck, A., et al., ‘’Preventing Intensive Care Unit Delirium: A Patient- Centered Approach to Reducing Sleep Disruption’’, Dimens Crit Care Nurs, 30(6),315-320, 2011.
• [17] Warshaw, G., Mechlin, M.,’’Prevention and management of postoperative delirium’’, Int Anesthesiol Clin, 47(4), 137-49, 2009.
• [18] Devlin, J.W., et al.,’’Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU’’ Crit Care Med, 46(9), 825-73, 2018.
• [19] Brummel, N.E., Girard, T.D., ‘’Preventing delirium in the intensive care unit’’ Crit Care Clin, 29(1), 51-65, 2013.
• [20] Köksal, G.M.,’’ Delirium’’, Retrieved from: http://turkishjic.org/archives/archive-detail/article-preview/deliryum/4266. (accessed 2/5/2020).
• [21] Simons, K.S., et al. ‘’Dynamic light application therapy to reduce the incidence and duration of delirium in intensive-care patients: a randomised controlled trial’’ Lancet Respir Med, 4(3),194-202, 2016.
• [22] Chevillon, C., et al., ‘’Preoperative Education on Postoperative Delirium, Anxiety, and Knowledge in Pulmonary Thromboendarterectomy Patients’’ Am J Crit Care, 24(2), 164-71, 2015.
• [23] Oh, E.S., et al., ‘’Delirium in Older Persons: Advances in Diagnosis and Treatment’’ JAMA, 318(12), 1161-74, 2017.
• [24] Karadas, C., Ozdemir, L.,’’The effect of range of motion exercises on delirium prevention among patients aged 65 and over in intensive care units’’, Geriatr Nurs NYN, 37(3),180–5, 2016.
• [25] Tomichek, J.E., et al.’’Antipsychotic prescribing patterns during and after critical illness: a prospective cohort study,’’ Crit Care, 20(1), 378, 2016.
• [26] Barr, J., et al., ‘’Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit’’, Crit Care Med, 41(1), 263-306, 2013.
• [27] Vallabhajosyula, S., et al., ‘’Role of statins in delirium prevention in critical ill and cardiac surgery patients: a systematic review and meta-analysis’’, J Crit Care, 37,189-96, 2017.
• [28] van den Boogaard M, et al., ‘’Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE randomized clinical trial’’, JAMA ,319(7), 680-90, 2018.
• [29] Avidan, M.S., et al., ‚‘Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial’’, Lancet, 390(10091), 267-75, 2017.
• [30] Schuurmans, M.J., et al., ‘’Early recognition of delirium: Review of the literature’’, J Clin Nurs, 10, 721-729, 2001.
• [31] Hipp, D.M., ‘’Pharmacological and Non-pharmacological Management of delirium in critically ill patients’’, Neurotherapeutics, 9(1), 158-175, 2012.
• [32] Kaplan Serin, E., ‘’Strategies to Reduce and Prevent Delirium in the ICU’’, Acute Brain Disfunction and Care. Bülbüloğlu S. (1. Ed). Çukurova Nobel Medicine Publisher, Antalya, Turkey, 139-146, 2020. (ISSN: 978-605-2369-29-6)
• [33] Maldonado, J.R., ‘’Delirium in the Acute Care Setting: Characteristics, Diagnosis and Treatment’’ Crit Care Clin , 24, 657-722, 2008.
• [34] Bülbüloğlu, S., ‘’Delirium Definition and Subgroups’’, Acute Brain Disfunction and Care. Bülbüloğlu S. (1. Ed). Çukurova Nobel Medicine Publisher, Antalya, Turkey, 1-8, 2020. (ISSN: 978-605-2369-29-6)
• [35] Inouye, S.K., et al., ‘’ Delirium in elderly people’’, Lancet, 383(9920), 911-922, 2014.
• [36] van Munster, B.C., et al., ‘’ Time‐course of cytokines during delirium in elderly patients with hip fractures’’, Journal of the American Geriatrics Society, 56(9), 1704-1709, 2008.
• [37] de Rooij, S.E., et al., ‘’Cytokines and acute phase response in delirium’’, Journal of psychosomatic research , 62(5), 521-525, 2007.
• [38] Adamis, D., et al., ‘’Cytokines and IGF-I in delirious and non-delirious acutely ill older medical inpatients’’, Age and ageing, 38(3), 326-332, 2009.
• [39] Wilson, K., et al., ‘’Plasma insulin growth factor-1 and incident delirium in older people’’, International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 20(2),154-159, 2005.
• [40] Mehta, P., et al., ‘’COVID-19: consider cytokine storm syndromes and immunosuppression’’, The Lancet, 395(10229), 1033-1034, 2020.
• [41] WHO., ‘’Coronavirus disease 2019 (COVID-19) situation report – 52’’, Retrieved from: https://www.who.int/docs/default-source/ coronaviruse/20200312-sitrep-52-covid-19. pdf?sfvrsn=e2bfc9c0_2 (accessed 21/05/2020).
• [42] Ruan, Q., et al., ‘’Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China’’, Intensive Care Med, 2020. DOI:10.1007/s00134-020-05991-x.
• [43] Lemstra, A.W., et al., ‘’Pre‐operative inflammatory markers and the risk of postoperative delirium in elderly patients’’, International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 23(9), 943-948, 2008.
• [44] Vilcek, J., ‘’First demonstration of the role of TNF in the pathogenesis of disease’’, The Journal of Immunology, 181(1), 5-6, 2008.
• [45] van Gool, W.A., et al., ‘’Systemic infection and delirium: when cytokines and acetylcholine collide’’, The Lancet, 375(9716), 773-5, 2010.
• [46] Cerejeira, J., et al., ‘’The neuroinflammatory hypothesis of delirium’’, Acta neuropathologica, 119(6), 737-754, 2010.
• [47] Ramos-Casals, M., et al., ‘’Adult haemophagocytic syndrome’’, Lancet, 383, 1503-16, 2014.
• [48] Karakike, E., Giamarellos-Bourboulis, E.J., ‘’Macrophage activation-like syndrome: a distinct entity leading to early death in sepsis’’, Front Immunol, 10, 55, 2019.
• [49] Seguin, A., et al., ‘’Pulmonary involvement in patients with hemophagocytic lymphohistiocytosis’’, Chest, 149, 1294-301, 2016.
• [50] Huang, C., et al., ‘’Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’’, Lancet, 395, 497-506, 2020.
• [51] Russell, C.D., et al., ‘Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury’’, Lancet, 395, 473-75, 2020.
• [52] Shakoory, B., et al., ‘’Interleukin-1 receptor blockade is associated with reduced mortality in sepsis patients with features of macrophage activation syndrome: reanalysis of a prior phase iii trial’’, Crit Care Med, 44, 275-81, 2016.
• [53] Kotfis, K., et al., ‘’COVID-19: ICU delirium management during SARS-CoV-2 pandemic’’, Critical Care, 24(1), 1-9, 2020.
• [54] Vasilevskis, E.E., et al.,’’The cost of ICU delirium and coma in the intensive care unit patient’’, Med Care, 56(10), 890-7, 2018.
• [55] Pandharipande, P.P., et al., ‘’Longterm cognitive impairment after critical illness’’, N Engl J Med, 369(14), 1306 -16, 2013.
• [56] Ely, E.W., ‘’The ABCDEF bundle: science and philosophy of how ICU liberation serves patients and families’’, Crit Care Med, 45(2), 321–30, 2017.
• [57] Vincent, J.L., et al., ‘’Comfort and patient-centred care without excessive sedation: the eCASH concept’’, Intensive Care Med, 42(6), 962 –71, 2016.
• [58] Marra, A., et al., ‘’Delirium monitoring: yes or no? That is the question’’, Am J Crit Care, 28(2), 127-35, 2019.
• [59] Meng, L., et al., ‘’Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan's Experience,’’ Anesthesiology, 2020. https://doi.org/10. 1097/ALN.0000000000003296.
• [60] Pérez, C.A., ‘’Looking ahead: The risk of neurologic complications due to COVID-19’’ Neurology: Clinical Practice, 2020.
• [61] Hwang, C., ‘’Olfactory neuropathy in severe acute respiratory syndrome: report of A case,’’ Acta Neurologica Taiwanica, 15(1), 26, 2016.
• [62] Desforges, M., et al., ‘’Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system?’’ Viruses, 12, 14, 2019.
• [63] Paterson, R.W., et al.,’’The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings’’, Brain, 2020