Delirium Confusional State
Conditions
Keywords
Intensive Care Unit, Sleep Promotion, Delirium Prevention, Nursing Intervention
Brief summary
Delirium is a common complication in intensive care units (ICUs) and may be associated with sleep disruption and frequent nighttime disturbances. This randomized controlled trial will evaluate whether a multicomponent nighttime sleep-promotion intervention, called the Triple Sleep-Promotion Protocol, can reduce the occurrence of new-onset delirium in adult ICU patients. The study is being conducted in four ICUs in Türkiye. Eligible patients who do not have delirium at the beginning of the study will be randomly assigned to either the intervention group or the control group. The intervention includes clustering nighttime nursing care, offering an eye mask and earplugs during protected sleep periods, and reducing avoidable nighttime light and noise whenever clinically feasible. Patients in the control group will receive usual ICU care. Patient safety and clinically necessary care will take priority over all sleep-promotion procedures. Participants will be followed during their ICU stay for up to five days. Delirium will be assessed twice daily using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Nighttime sleep quality will also be assessed each morning using the Richards-Campbell Sleep Questionnaire. The primary aim is to determine whether the Triple Sleep-Promotion Protocol reduces the incidence of new-onset delirium compared with usual ICU care.
Detailed description
Sleep disruption is common among critically ill patients and may contribute to the development of delirium. Nighttime sleep in the ICU can be disrupted by environmental light and noise, frequent nursing activities, monitoring, and other clinically necessary procedures. Non-pharmacological strategies that reduce avoidable nighttime disturbances may therefore represent a feasible approach to supporting sleep and preventing delirium without adding medication-related risks. The Triple Sleep-Promotion Protocol was developed as a multicomponent nursing intervention integrating clustered nighttime nursing care, protected sleep periods, eye mask and earplug use, and pragmatic reduction of avoidable nighttime light and noise. The protocol is designed to reduce modifiable sleep disturbances while maintaining routine clinical monitoring and prioritizing patient safety and necessary care at all times. This multicenter randomized controlled trial will examine whether implementation of the Triple Sleep-Promotion Protocol reduces new-onset delirium compared with usual ICU care. The study will also evaluate subjective nighttime sleep quality and document intervention adherence and clinically necessary protocol interruptions.
Interventions
OTHERTriple Sleep-Promotion Protocol
The Triple Sleep-Promotion Protocol is a multicomponent, non-pharmacological nighttime nursing intervention implemented approximately between 22:00 and 08:00. Nursing care is clustered within three designated periods (22:00-01:00, 02:30-04:00, and 05:30-07:00) to support two protected sleep periods (01:00-02:30 and 04:00-05:30). During the protected sleep periods, participants are offered an eye mask and earplugs, and avoidable environmental light and noise are reduced whenever clinically feasible. Urgent or clinically necessary nursing care, medical procedures, monitoring, and patient safety requirements take priority over the protocol. If the evening RASS score is -4 or -5, the sleep-promotion intervention is withheld for that night and the participant is reassessed subsequently. The intervention is discontinued after the first positive CAM-ICU assessment.
Sponsors
Naile ALANKAYA
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Masking description
Due to the nature of the intervention, participants, care providers, investigators, and outcome assessors are not masked to group allocation. However, the statistician performing the primary analyses will be blinded to treatment allocation. The groups will be provided using coded labels, and treatment identity will not be disclosed until the prespecified primary analyses have been completed.
Intervention model description
Participants are individually randomized in a 1:1 ratio to either the Triple Sleep-Promotion Protocol plus usual ICU care or usual ICU care alone. Randomization is stratified by study center using variable block sizes of 4 and 6.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older. * Admitted to one of the participating intensive care units. * Expected ICU stay of at least 24 hours. * Richmond Agitation-Sedation Scale (RASS) score between -3 and +4 at baseline. * Negative Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessment at baseline. * Able to communicate in Turkish when communication is required for study assessments. * Written informed consent provided by the patient or, when the patient is unable to provide consent because of their clinical condition, by a first-degree relative.
Exclusion criteria
* Positive CAM-ICU assessment at baseline. * Dementia or a severe neurological disorder that may interfere with delirium assessment, including stroke or severe head trauma. * Delirium related to alcohol or substance withdrawal. * Visual or hearing impairment that prevents implementation of the sleep-promotion intervention. * Ear infection or tympanic membrane perforation that precludes the use of earplugs. * Terminal clinical condition.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of New-Onset Delirium | Up to 5 days after randomization | New-onset delirium is defined as at least one positive Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) assessment during ICU follow-up. Only participants who are CAM-ICU negative at baseline are randomized. Richmond Agitation-Sedation Scale (RASS) is assessed before each CAM-ICU assessment; CAM-ICU is performed when RASS is -3 or higher, while RASS -4 or -5 is recorded as not assessable. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Subjective Sleep Quality Assessed by the Richards-Campbell Sleep Questionnaire | Daily during ICU follow-up, up to 5 days after randomization | Subjective sleep quality is assessed using the Richards-Campbell Sleep Questionnaire (RCSQ), a five-item instrument evaluating the preceding night's sleep. Each item is scored from 0 to 100, and the mean of the five items is calculated as the overall RCSQ score (range: 0-100). Higher scores indicate better perceived sleep quality. The RCSQ is administered each morning between 07:00 and 08:00 during ICU follow-up. Assessments are discontinued after the first positive CAM-ICU assessment. |
Countries
Turkey (Türkiye)
Contacts
CONTACTNaile Alankaya, Assosiate Prof. PhD
CONTACTSevda Ateş
PRINCIPAL_INVESTIGATORNaile Alankaya
Çanakkale Onsekiz Mart University, Faculty of Health Sciences
Outcome results
None listed