ArticleJournal of intensive care2025
Effects of a multicomponent sleep enhancement protocol on delirium incidence in elderly critically ill surgical patients: a randomized controlled trial.
Article in Journal of intensive care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Auricular Vagus Nerve Stimulation Reduces Postoperative Delirium After Major Non-Cardiac Surgery in Elderly Patients.Clinical interventions in aging · 2026Trial
- Recent Evidence on Factors and Potential Interventions Affecting Patient Sleep in Inpatient and Hospital Settings.Current psychiatry reports · 2026Review
- Effectiveness of Non-Pharmacological Interventions for the Prevention of Postoperative Delirium in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis.Nursing reports (Pavia, Italy) · 2026Review
- Neurological Complications in Intensive Care Units: From Delirium to Long-Term Cognitive Dysfunction-A Narrative Review.Journal of clinical medicine · 2026Review
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSleep disturbances are common in critically ill patients and increase delirium risk, leading to worse outcomes. Non-pharmacologic sleep interventions show mixed results, with limited randomized controlled trial (RCT) data in surgical ICU populations.
methodsWe conducted a prospective, single-blind randomized controlled trial in a surgical ICU to evaluate a multicomponent sleep enhancement protocol vs. usual care in patients aged ≥ 65 years with expected ICU stays > 24 h. The intervention included environmental modifications (noise and light reduction, closed doors, alarm adjustments) and patient-specific measures (earplugs, eye masks). Delirium incidence over 7 days was assessed using the Thai version of CAM-ICU by blinded evaluators. Sleep quality was measured daily with the Richards-Campbell Sleep Questionnaire (RCSQ). Bayesian methods estimated treatment effects and posterior probabilities of benefit.
resultsOf 177 patients analyzed (89 intervention, 88 control), delirium occurred in 10.1% of the intervention group vs. 17.0% in controls (Bayesian OR 0.55; 95% credible interval [CrI] 0.22-1.31; posterior probability of benefit 90.6%). In a predefined high-risk subgroup, delirium incidence was 14.0% vs. 30.0% (OR 0.38; 95% CrI 0.12-1.83; posterior probability of benefit 95.7%). Sleep quality scores and clinical outcomes did not differ significantly. Adherence was high for environmental modifications but moderate for earplugs and eye masks.
conclusionsAmong elderly surgical ICU patients, a multicomponent, non-pharmacologic sleep enhancement protocol was associated with a high posterior probability of reducing delirium during the early ICU period, despite no measurable improvement in subjective sleep quality. The findings are hypothesis-generating; given the protocol's simplicity and low risk, confirmation in larger multicenter trials with objective sleep measures and strategies to optimize adherence is warranted.
trial registrationThis study was registered with the Thai Clinical Trials Registry (TCTR: https://www.thaiclinicaltrials.org ) under the registration number TCTR20221129003, with the registration date of 29 November 2022. TCTR20221129003.
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