» Articles » PMID: 30782719

Relaxation for Critically Ill Patient Outcomes and Tress-coping Enhancement (REPOSE): a Protocol for a Pilot Randomised Trial of an Integrative Intervention to Improve Critically Ill Patients' Delirium and Related Outcomes

Abstract

Introduction: Delirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes.

Methods And Analysis: Randomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18-64 years and ≥65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0-3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC ≥4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated.

Ethics And Dissemination: The study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial.

Trial Registration Number: NCT02905812; Pre-results.

Citing Articles

Heart rate variability and delirium in acute non-cardioembolic stroke: a prospective, cross-sectional, cohort study.

Rollo E, Marotta J, Callea A, Brunetti V, Vollono C, Scala I Neurol Sci. 2021; 43(4):2423-2431.

PMID: 34586543 PMC: 8918184. DOI: 10.1007/s10072-021-05621-4.

References
1.
Milbrandt E, Deppen S, Harrison P, Shintani A, Speroff T, Stiles R . Costs associated with delirium in mechanically ventilated patients. Crit Care Med. 2004; 32(4):955-62. DOI: 10.1097/01.ccm.0000119429.16055.92. View

2.
Barr J, Fraser G, Puntillo K, Wesley Ely E, Gelinas C, Dasta J . Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2012; 41(1):263-306. DOI: 10.1097/CCM.0b013e3182783b72. View

3.
MacLullich A, Ferguson K, Miller T, de Rooij S, Cunningham C . Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008; 65(3):229-38. PMC: 4311661. DOI: 10.1016/j.jpsychores.2008.05.019. View

4.
Chlan L, Halm M . Does music ease pain and anxiety in the critically ill?. Am J Crit Care. 2013; 22(6):528-32. DOI: 10.4037/ajcc2013998. View

5.
Serpa Neto A, Nassar Jr A, Cardoso S, Manetta J, Pereira V, Esposito D . Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2012; 40(6):1946-51. DOI: 10.1097/CCM.0b013e31824e16c9. View