Tamamlayıcı ve İntegratif Müdahalelerin Erişkin Yoğun Bakım Hastalarında Ağrı ve Deliryum Yönetimi Üzerindeki Etkileri: Sistematik Derleme ve Meta Analiz Çalışması

Abstract

The aim of this systematic review and meta-analysis is to systematically synthesize randomized controlled trials in which complementary and integrative interventions applied for pain and delirium management in intensive care patients and to examine the effects of these methods on pain and delirium. In the study, using the keywords “critical care, complementary therapies, alternative therapies, pain, delirium, randomised controlled study” and their combinations in line with the Medical Subject Headings (MeSH) terminology, the researchers independently searched eight databases including Cochrane Controlled Register of Trials (CENTRAL), Web of Science, PubMed, Scopus, EBSCOhost / CINAHL Complete, Springer Link, ScienceDirect and Ovid MEDLINE until 27 April 2024 without a year limitation. A total of 24 randomized controlled trials examining the effects of complementary and integrative interventions on pain (n=13) and delirium (n=11) in intensive care unit patients were included in the systematic review and meta-analysis. The quality assessment of the studies was performed by two independent researchers and evaluated using “RoB 2: Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2)”. According to the meta-analysis results of the included studies, complementary and integrative interventions had a significant and large effect on pain in intensive care patients (g = 0.977, 95% confidence interval (CI) = -1.403 to -0.552; p < 0.001) and a significant and reducing effect on delirium (OR = 0.522, 95% CI = 0.316 to 0.865; p = 0.012). In line with the forest plot and indicators related to statistical tests, heterogeneity between the individual studies included in the analysis was found to be high for both pain (I2 = 89.27%; p = 0.000) and delirium (I2 = 91.45%; p < 0.001) variables. According to the results of the variance meta-analysis in which individual interventions were used as moderators, it was determined that music intervention was more effective in reducing pain intensity (g = -0.799, 95% confidence interval (CI) = -1.523 to -0.075; p = 0.001) and exercise intervention was more effective in reducing the incidence of delirium (OR = 0.353, 95% CI = 0.218-0.571; p = 0.000). In line with the findings obtained as a result of this study, it is recommended to plan and implement more randomized controlled studies in which complementary and integrative interventions to be applied to intensive care patients to provide pain and delirium management are diversified and conducted on large sample groups with multidisciplinary team understanding and multicenter research. This study was registered in the PROSPERO database with the number ID=CRD42018102914.