Intervenciones de Enfermería en la Prevención del Delirium en Pacientes Críticos: Revisión Sistemática
Nursing interventions in the prevention of delirium in critically ill patients: a systematic review
DOI:
https://doi.org/10.56712/latam.v6i4.4313Palabras clave:
delirium, enfermería, prevención, cuidados intensivos, intervenciones no farmacológicasResumen
El delirium representa una complicación frecuente en unidades de cuidados intensivos, asociada con resultados clínicos adversos. Este estudio tuvo como objetivo analizar las intervenciones de enfermería orientadas a la prevención del delirium, evaluando su eficacia, características operativas y aplicabilidad clínica. Se realizó una revisión sistemática conforme a la declaración PRISMA 2020, incluyendo estudios publicados entre enero de 2021 y mayo de 2025 en inglés y español. Se consultaron las bases de datos PubMed, Sciencedirect, Taylor & Francis y SciELO, utilizando descriptores MeSH y DeCS. Se incluyeron ensayos clínicos, estudios cuasiexperimentales y observacionales que abordaran intervenciones no farmacológicas implementadas por enfermería en pacientes adultos críticos. Se seleccionaron nueve estudios, los cuales fueron analizados mediante síntesis narrativa. La mayoría de las intervenciones fueron multicomponentes, combinando estrategias como reorientación cognitiva, movilización precoz, control del ambiente, acompañamiento familiar y promoción del sueño. Los resultados evidenciaron una reducción en la incidencia, duración y severidad del delirium, así como mejoras en parámetros clínicos como la ventilación mecánica y la estancia en UCI. La calidad metodológica de los estudios se evaluó mediante el sistema GRADE, con predominio de evidencia moderada y recomendaciones fuertes. Se concluye que las intervenciones de enfermería no farmacológicas, especialmente las estructuradas, resultan efectivas para prevenir el delirium en sujetos críticamente enfermos, y su integración en protocolos clínicos puede fortalecer el abordaje preventivo en entornos intensivos.
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Akpinar, R. B., Aksoy, M., & Kant, E. (2022). Effect of earplug/eye mask on sleep and delirium in intensive care patients. Nursing in Critical Care, 27(4), 537-545. https://doi.org/10.1111/nicc.12741
Aldawood, Z. S., Alameri, R. A., Elghoneimy, Y., Swyan, A. H. A., Almulla, H., Hammad, S. S., Saleh, N. S. A., & Alameri, S. A. (2023). Impact of Educational Program on Critical Care Nurses’ Knowledge of ICU Delirium: A Quasi-Experimental Study. Medical Archives (Sarajevo, Bosnia and Herzegovina), 77(1), 56-63. https://doi.org/10.5455/medarh.2023.77.56-63
Balas, M. C., Burke, W. J., Gannon, D., Cohen, M. Z., Colburn, L., Bevil, C., Franz, D., Olsen, K. M., Ely, E. W., & Vasilevskis, E. E. (2013). Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: Opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines. Critical Care Medicine, 41(9 Suppl 1), S116-127. https://doi.org/10.1097/CCM.0b013e3182a17064
Barr, J., Downs, B., Ferrell, K., Talebian, M., Robinson, S., Kolodisner, L., Kendall, H., & Holdych, J. (2024). Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System. Critical Care Explorations, 6(1), e1001. https://doi.org/10.1097/CCE.0000000000001001
Deng, L.-X., Cao, L., Zhang, L.-N., Peng, X.-B., & Zhang, L. (2020). Non-pharmacological interventions to reduce the incidence and duration of delirium in critically ill patients: A systematic review and network meta-analysis. Journal of Critical Care, 60, 241-248. https://doi.org/10.1016/j.jcrc.2020.08.019
Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., Watson, P. L., Weinhouse, G. L., Nunnally, M. E., Rochwerg, B., Balas, M. C., van den Boogaard, M., Bosma, K. J., Brummel, N. E., Chanques, G., Denehy, L., Drouot, X., Fraser, G. L., Harris, J. E., … Alhazzani, W. (2018). Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299
Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell, F. E., Inouye, S. K., Bernard, G. R., & Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA, 291(14), 1753-1762. https://doi.org/10.1001/jama.291.14.1753
Fazlollah, A., Babatabar Darzi, H., Heidaranlu, E., & Moradian, S. T. (2021). The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complementary Therapies in Medicine, 60, 102738. https://doi.org/10.1016/j.ctim.2021.102738
Girard, T. D., Thompson, J. L., Pandharipande, P. P., Brummel, N. E., Jackson, J. C., Patel, M. B., Hughes, C. G., Chandrasekhar, R., Pun, B. T., Boehm, L. M., Elstad, M. R., Goodman, R. B., Bernard, G. R., Dittus, R. S., & Ely, E. W. (2018). Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: A prospective cohort study. The Lancet. Respiratory Medicine, 6(3), 213-222. https://doi.org/10.1016/S2213-2600(18)30062-6
Gómez Tovar, L. O., & Henao Castaño, A. M. (2024). Dynamic delirium – Nursing intervention to reduce delirium in patients critically Ill, a randomized control trial. Intensive and Critical Care Nursing, 83, 103691. https://doi.org/10.1016/j.iccn.2024.103691
Hsiao, W.-L., Hsieh, P.-Y., Hsu, L.-F., Lai, Y.-H., Wang, M.-L., & Yeh, Y.-C. (2024). Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study. Journal of Clinical Anesthesia, 98, 111566. https://doi.org/10.1016/j.jclinane.2024.111566
Hu, R.-F., Jiang, X.-Y., Chen, J., Zeng, Z., Chen, X. Y., Li, Y., Huining, X., & Evans, D. J. W. (2015). Non-pharmacological interventions for sleep promotion in the intensive care unit. The Cochrane Database of Systematic Reviews, 2015(10), CD008808. https://doi.org/10.1002/14651858.CD008808.pub2
Johnson, G. U., Towell-Barnard, A., McLean, C., & Ewens, B. (2024). Delirium prevention and management in an adult intensive care unit through evidence-based nonpharmacological interventions: A scoping review. Collegian, 31(4), 232-251. https://doi.org/10.1016/j.colegn.2024.05.001
Kiliç, G., & Kav, S. (2023). Effect of using eye masks and earplugs in preventing delirium in intensive care patients: A single-blinded, randomized, controlled trial. Nursing in Critical Care, 28(5), 698-708. https://doi.org/10.1111/nicc.12901
Kotfis, K., Williams Roberson, S., Wilson, J. E., Dabrowski, W., Pun, B. T., & Ely, E. W. (2020). COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Critical Care (London, England), 24(1), 176. https://doi.org/10.1186/s13054-020-02882-x
Krewulak, K. D., Stelfox, H. T., Leigh, J. P., Ely, E. W., & Fiest, K. M. (2018). Incidence and Prevalence of Delirium Subtypes in an Adult ICU: A Systematic Review and Meta-Analysis. Critical Care Medicine, 46(12), 2029-2035. https://doi.org/10.1097/CCM.0000000000003402
Krüger, L., Zittermann, A., Mannebach, T., Wefer, F., Becker, T., Lohmeier, S., Lüttermann, A., von Dossow, V., Rojas, S. V., Gummert, J., & Langer, G. (2024). Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay. Intensive and Critical Care Nursing, 84, 103748. https://doi.org/10.1016/j.iccn.2024.103748
Liang, S., Chau, J. P. C., Lo, S. H. S., Zhao, J., & Liu, W. (2022). Non-pharmacological delirium prevention practices among critical care nurses: A qualitative study. BMC Nursing, 21, 235. https://doi.org/10.1186/s12912-022-01019-5
Lin, H., Dong, D., Zheng, K., & Xu, Q. (2025). A Comprehensive Intervention Program for Postoperative Delirium Prevention in Elderly Patients Undergoing Cardiac Surgery. Journal of PeriAnesthesia Nursing, 40(2), 371-376. https://doi.org/10.1016/j.jopan.2024.05.018
Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle in Critical Care. Critical care clinics, 33(2), 225-243. https://doi.org/10.1016/j.ccc.2016.12.005
Matsuura, Y., Ohno, Y., Toyoshima, M., & Ueno, T. (2023). Effects of non-pharmacologic prevention on delirium in critically ill patients: A network meta-analysis. Nursing in Critical Care, 28(5), 727-737. https://doi.org/10.1111/nicc.12780
Oh, E. S., Fong, T. G., Hshieh, T. T., & Inouye, S. K. (2017). Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA, 318(12), 1161-1174. https://doi.org/10.1001/jama.2017.12067
Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., … Ely, E. W. (2019). Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Critical Care Medicine, 47(1), 3-14. https://doi.org/10.1097/CCM.0000000000003482
Sist, L., Pezzolati, M., Ugenti, N. V., Cedioli, S., Messina, R., Chiappinotto, S., Rucci, P., & Palese, A. (2024). Nurses prioritization processes to prevent delirium in patients at risk: Findings from a Q-Methodology study. Geriatric Nursing, 58, 59-68. https://doi.org/10.1016/j.gerinurse.2024.05.002
Tonna, J. E., Dalton, A., Presson, A. P., Zhang, C., Colantuoni, E., Lander, K., Howard, S., Beynon, J., & Kamdar, B. B. (2021). The Effect of a Quality Improvement Intervention on Sleep and Delirium in Critically Ill Patients in a Surgical ICU. Chest, 160(3), 899-908. https://doi.org/10.1016/j.chest.2021.03.030
Topal, T., & Sürme, Y. (2025). The Effect of Music and Eye Masks on Sleep Quality and Delirium in Abdominal Surgery Intensive Care Patients: Randomized Controlled Trial. Nursing in Critical Care, 30(4), e70072. https://doi.org/10.1111/nicc.70072
Torres Contreras, C. C., Páez-Esteban, A. N., Rincon-Romero, M. K., Rivera Carvajal, R., Márquez Herrera, M., & Hinestrosa Díaz del Castillo, A. (2021). Nursing intervention to prevent delirium in critically ill adults. Revista Da Escola de Enfermagem Da USP, 55, e03685. https://doi.org/10.1590/S1980-220X2019035003685
Torres-Contreras, C. C., Esteban, A. N. P., Parra, M. D., Romero, M. K. R., Silva, C. G. da, & Buitrago, N. P. D. (2021). Multicomponent nursing program to prevent delirium in critically ill patients: A randomized clinical trial. Revista Gaucha De Enfermagem, 42, e20200278. https://doi.org/10.1590/1983-1447.2021.20200278
Yin, S., Dai, J., & Lu, L. (2024). Summary of the Clinical Evidence for Non-Pharmacological Management of Postoperative Delirium in Adults: An Evidence Synthesis. Journal of Multidisciplinary Healthcare, 17, 3427-3438. https://doi.org/10.2147/JMDH.S469157
Zaal, I. J., Devlin, J. W., Peelen, L. M., & Slooter, A. J. C. (2015). A systematic review of risk factors for delirium in the ICU. Critical Care Medicine, 43(1), 40-47. https://doi.org/10.1097/CCM.0000000000000625
Zhang, Z., Pan, L., & Ni, H. (2013). Impact of delirium on clinical outcome in critically ill patients: A meta-analysis. General Hospital Psychiatry, 35(2), 105-111. https://doi.org/10.1016/j.genhosppsych.2012.11.003
