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Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses

View Article: PubMed Central - PubMed

ABSTRACT

Background: Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence.

Methods: We will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software.

Discussion: This systematic review will address the existing knowledge gap regarding best practices for delirium prevention in critically ill adults by synthesizing evidence from trials of pharmacological, non-pharmacological, and multi-component interventions administered in or prior to transfer to the ICU. Use of network meta-analysis will clarify which delirium prevention strategies are most effective in improving clinical outcomes while causing least harm. The network meta-analysis is a novel approach and will provide knowledge users and decision makers with comparisons of multiple interventions of delirium prevention strategies.

Systematic review registration: PROSPERO CRD42016036313

Electronic supplementary material: The online version of this article (doi:10.1186/s13643-016-0327-0) contains supplementary material, which is available to authorized users.

No MeSH data available.


Interventions eligible for network meta-analysis. Lines reflect where comparisons may exist between treatments. Which comparisons have been studied will be established by studies identified. Availability of outcomes can also impact network structure. Clinical experts have guided the network refinement
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Fig1: Interventions eligible for network meta-analysis. Lines reflect where comparisons may exist between treatments. Which comparisons have been studied will be established by studies identified. Availability of outcomes can also impact network structure. Clinical experts have guided the network refinement

Mentions: An NMA is capable of estimating comparisons of multiple interventions based on both direct and indirect evidence [20–22]. Using this unique approach, we will include all trials evaluating any of the aforementioned strategies, regardless of the intervention used in the control arm (i.e., whether the study compares one delirium prevention strategy to another, placebo, or care as usual (Fig. 1)). Descriptions of care as usual will be extracted verbatim from studies to ensure that similarities and differences are appropriately reflected in the NMA.Fig. 1


Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses
Interventions eligible for network meta-analysis. Lines reflect where comparisons may exist between treatments. Which comparisons have been studied will be established by studies identified. Availability of outcomes can also impact network structure. Clinical experts have guided the network refinement
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016934&req=5

Fig1: Interventions eligible for network meta-analysis. Lines reflect where comparisons may exist between treatments. Which comparisons have been studied will be established by studies identified. Availability of outcomes can also impact network structure. Clinical experts have guided the network refinement
Mentions: An NMA is capable of estimating comparisons of multiple interventions based on both direct and indirect evidence [20–22]. Using this unique approach, we will include all trials evaluating any of the aforementioned strategies, regardless of the intervention used in the control arm (i.e., whether the study compares one delirium prevention strategy to another, placebo, or care as usual (Fig. 1)). Descriptions of care as usual will be extracted verbatim from studies to ensure that similarities and differences are appropriately reflected in the NMA.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence.

Methods: We will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software.

Discussion: This systematic review will address the existing knowledge gap regarding best practices for delirium prevention in critically ill adults by synthesizing evidence from trials of pharmacological, non-pharmacological, and multi-component interventions administered in or prior to transfer to the ICU. Use of network meta-analysis will clarify which delirium prevention strategies are most effective in improving clinical outcomes while causing least harm. The network meta-analysis is a novel approach and will provide knowledge users and decision makers with comparisons of multiple interventions of delirium prevention strategies.

Systematic review registration: PROSPERO CRD42016036313

Electronic supplementary material: The online version of this article (doi:10.1186/s13643-016-0327-0) contains supplementary material, which is available to authorized users.

No MeSH data available.