NCT06036017

Care Bundle's Impact on Delirium Prevention in CABG Patients

Determining the Effect of Care Package Implementation in Preventing Delirium in Patients Undergoing Coronary Artery Bypass Graft Surgery

• Status: Unknown
• Phase: N/A
• Study type: Interventional
• Enrollment: 128 (estimated)
• Sponsor: İslam Elagöz · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Accepted

Summary

This research investigates the effectiveness of a care package used in the care of patients undergoing coronary artery bypass graft (CABG) surgery in preventing postoperative delirium. CABG surgery is a common procedure used to increase blood flow to the heart and is typically applied in patients with severe cardiac diseases. However, this procedure can increase the risk of postoperative delirium, especially among elderly and critically ill patients. In this study, the goal is to reduce this risk by implementing a care package. The care package includes optimal pain management, sleep regulation, mobilization, ensuring patient orientation, and appropriate medication management. The results of the research will be used to determine whether the use of this care package is effective in reducing the risk of delirium after CABG surgery. This could potentially improve patient outcomes and allow for more efficient use of hospital resources.

Detailed description

Open-heart surgery is an effective treatment method used in the treatment of heart diseases today. However, after this operation, patients are at risk of postoperative delirium, which negatively affects the patient's recovery process. Open-heart surgery is a commonly performed surgical procedure; despite technological advancements and improvements in hospital care, delirium after open-heart surgery remains a common complicationDelirium, a condition causing acute dysfunction in the brain, leads to changes in patients' mental states and impairments in cognitive functions. Delirium after open-heart surgery is a common complication and can increase the patient's morbidity and mortality. Delirium extends the hospital stay and increases patient care costs. Therefore, it is important to implement a special care package to reduce the risk of delirium. The frequency of delirium in patients undergoing open-heart surgery varies between 20% and 50%. The post-open-heart surgery delirium prevention care package is a series of practices designed to reduce the patient's delirium risk. These practices may include; maintaining a regular sleep pattern, noise control, balancing hormone levels, family proximity, and music therapy. Antipsychotic drugs, a pharmacological agent, are commonly used in the treatment of delirium. These drugs help to alleviate the symptoms of delirium and make the patient more calm. However, antipsychotic drugs are effective in symptom management and their side effects worsen the patient's condition and the effectiveness of antipsychotic drugs on delirium is doubtful. It is extremely important to avoid routine application of antipsychotic drugs. Instead, non-pharmacological methods are preferred, such as providing a suitable environment, regulating noise and light levels, maintaining sleep patterns, increasing physical activity, preventing unnecessary drug use, and regulating fluid and electrolyte balance. These methods can reduce the risk of delirium and help the patient undergo a faster and more successful recovery process. There is a significant place in the literature for non-pharmacological methods for the prevention of delirium. These methods include ensuring the suitability of the environment the patient is in, regulating sleep schedules, keeping noise and light levels under control, psychological support and rehabilitation, pain and symptom management, prevention of sensory disorders, reducing invasive procedures, increasing physical activity, encouraging sleep, preventing unnecessary drug use, family-centered care, regulating fluid and electrolyte balance, and arranging nutritional order. The implementation of these methods can help avoid delirium risk factors and contribute to a faster recovery process for the patient. Delirium is a very distressing condition for family members, especially those who observe delirium attacks. This situation can also have lasting effects on patients who remember delirium attacks in the hospital. It can also cause difficulties for the healthcare personnel caring for these patients. Therefore, it is extremely important to take the best possible precautions against delirium attacks or to treat the disease. Family-centered care is an important factor in reducing the risk of delirium in patients during the postoperative period. Family members can be by the patients' side, provide moral support, and help patients feel more peaceful and comfortable in the postoperative period. Family members' support can reduce the patient's delirium risk, as it helps the patient maintain a familiar environment. A support network can also be critical in observing symptoms of delirium and ensuring appropriate treatment is sought. Involvement of family members in patient care can be beneficial in many ways. For example, they can help orient the patient to time, place, and situation, provide emotional support, and communicate the patient's needs and preferences to the healthcare team. They can also encourage the patient to engage in physical activity, eat, and drink, which can help maintain their overall health and well-being. Music therapy, one of the non-pharmacological methods, is also known to be effective in preventing delirium after open-heart surgery. Music therapy can help to reduce anxiety and promote relaxation, both of which can aid in delirium prevention. In addition to these, maintaining a regular sleep pattern, controlling noise levels, and balancing hormone levels can be very effective in reducing the risk of delirium. Disruptions in sleep can lead to a higher risk of delirium, so ensuring the patient has a quiet and calm environment for rest can be crucial. In conclusion, prevention of delirium after open-heart surgery is vital for the successful recovery of patients. A multi-faceted approach that includes non-pharmacological interventions such as environmental modifications, family-centered care, music therapy, and maintaining a regular sleep pattern, in addition to pharmacological treatments when necessary, is likely to be most effective. Further research is needed to identify the most beneficial and feasible interventions for preventing delirium after open-heart surgery.

Conditions

• Delirium
• Bypass Complication
• Coronary Artery Bypass
• Patient Care Bundles

Interventions

Type	Name	Description
OTHER	Earplugs	There are numerous studies that suggest using earplugs can regulate a patient's sleep and may reduce the risk of delirium (Locihova 2017) (Van Rompaey 2012). However, there is no hard and fast rule concerning the duration, timing, and preference of earplug use. The duration of earplug use may vary and will be determined based on the needs of the patient, and it will be ensured that they are used throughout the night (Rompaey 2012).
OTHER	Music Therapy	Music therapy will be applied to help the patient relax and fall asleep. Moreover, the choice of music genre will be suitable for the patient's preferences, and it will be ensured that it is played at a low volume. Specific guidelines will be applied regarding the frequency and duration of music therapy, it will be performed twice a day after surgery at a low volume and via headphones, each session lasting 30 minutes (Sibenda A et al. 2019).
OTHER	Presence of Family After Extubation:	According to the guidelines titled 'Family presence and visit in Adult ICU' published by the American Association of Critical Care Nurses (AACN) in 2012; it is recommended that a family member or friend chosen by the patient be present to provide 24-hour uninterrupted emotional and social support for patients in intensive care. Allowing the patient's family to visit helps maintain the patient's social connections and contributes to the psychological well-being of the patient with family support. In addition to routine visits, patients' families can spend longer periods with the patient during their intensive care process and information about the patient is conveyed to close family members. Research shows that family presence in the intensive care unit reduces the incidence of delirium (Eghbali-Babadi, 2017) (Rosa 2017).

Timeline

• Start date: 2024-01-01
• Primary completion: 2024-08-30
• Completion: 2024-08-30
• First posted: 2023-09-13
• Last updated: 2024-01-17

Locations

1 site across 1 country: Turkey (Türkiye)