The impact of delirium nursing preventive interventions on long-term quality of life and cognitive functioning in the critically ill: a multicenter randomized controlled trial

Abstract

Background. Delirium frequently occurs in the intensive care unit and is associated with impaired long-term outcomes. The nUrsiNg DEliRium Preventive INterventions in the Intensive Care Unit (UNDERPIN-ICU) program consists of nursing and physical therapy interventions that target four modifiable risk factors of delirium (visual and hearing impairment, sleep deprivation, cognitive impairment, and immobility). The long-term effects of this program are currently unknown. Aim. To determine the effect of the UNDERPIN-ICU program on long-term quality of life and cognitive functioning. Methods. This study is a preliminary analysis of the secondary outcomes of a multicenter randomized trial in which critically ill adults who were at high risk of developing delirium were assigned either to the UNDERPIN-ICU or to usual care. Quality of life and cognitive functioning were assessed using the Short Form(36) and Cognitive Failure Questionnaire(14) questionnaires at intensive care admission (baseline) and after three months. Quality of life was summarized in physical and mental components scores. Differences between groups were analyzed. Results. In total, 571 patients were included, of which 107 were analyzed for quality of life and 126 for cognitive functioning. Quality of life did not differ between the UNDERPIN-ICU and usual care groups (physical component mean scores were 35±14 and 37±12, respectively, p=0.63; mental component scores were 39±14 and 40±13, respectively, p=0.87). Cognitive function did not differ between the groups (sum score median 25[12-34] and 24[16-33], respectively, p=0.25). Conclusions. The UNDERPIN-ICU program did not improve long-term quality of life or cognitive functioning. The results are based on preliminary analysis and should be interpreted with caution. Implication of key findings. As the survivability of ICU admission increases, focus on long-term outcomes becomes increasingly important. More research is needed to determine the impact of the UNDERPIN-ICU program on these outcomes.