Annotated Bibliography: Reducing ICU Delirium

Annotated Bibliography: Reducing ICU Delirium
Emily Wagner
Chamberlain College of Nursing
NR 500 Foundational Concepts and Applications

Annotated Bibliography: Reducing ICU Delirium
Balas, M. C., Vasilevskis, E. E., Burke, W. J., Boehm, L., Pun, B. T., Olsen, K. M., … Ely, E. W. (2012). Critical care nurses’ role in implementing the “ABCDE” bundle into practice. Critical Care Nurse, 32(2), 35-47. http://dx.doi.org/10.4037/ccn2012229
This article was written by a group of university professors at schools of medicine, research nurses, and a program clinical manager. The authors summarize the recent peer-reviewed research contributing to the development of the ABCDE bundle and further explain each component. Research supports
The authors of this article are part of a task force of nurses, pharmacists, administrators, respiratory therapists, and physicians. A systematic review of current peer-reviewed research was used to develop the new protocol. The study used a large study size of 1,483 patients divided into the control and intervention groups at three university hospitals. The study concluded that the new protocol resulted in a decrease of benzodiazepine dose, days on the ventilator, delirium rates, and ICU length of stay. A limit of the study was implementation at only three hospitals where protocols were already in place. This article is relevant to the clinical question by studying the intended patient population, decreasing benzodiazepine use, and studies the outcomes of reduced delirium rates and length of stay. This article was found during a search of the Medline database.
Mehta, S., Burry, L., Cook, D., Fergusson, D., Steinburg, M., Granton, J., … Meade, M. (2012). Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. Journal of the American Medical Association, 308(19), 1985-1992. doi:
The study was performed in the medical surgical ICU and surgical ICU at a hospital in St. Louis, MO. Inclusion and exclusion criteria for both the before participants and after participants was clearly identified. A large enough study group was chosen with 199 participants split between the before and after groups. The study examined the clinical question aspects of: patients on mechanical ventilation, a sedation protocol reducing benzodiazepine use, the incidence of delirium, and reduced time on the ventilator. Results of the study concluded that early dexmedetomidine use replacing benzodiazepines reduced the amount of time on the ventilator and ICU length of stay. However, an unexpected side effect of the dexmedetomidine infusion was an increase in ICU delirium. Also, about 25% of patients had to stop the dexmedetomidine infusion due to intolerance as evidenced by bradycardia or hypotension. The authors of the study were well-qualified and included pharmacists, anesthesiologists, an emergency doctor of medicine, and an intensivist. All research was current and peer-reviewed. This article was found during a search of