Role of Nursing Interventions in Preventing Delirium in the Cardiac Surgery Intensive Care Unit: A Prospective Cohort Study

Abstract

Background: Delirium is a common to and life-threatening complication in the Cardiac Surgery Intensive Care Unit (CSICU), which is linked to a prolonged period of mechanical ventilation, a long duration of hospitalization, and cognitive impairment. Although it is becoming more apparent that structured nursing interventions may decrease the prevalence of delirium, their implementation and efficacy in the CSICU setting have not been examined thoroughly.

Methods: The prospective and controlled cohort study was carried out in one tertiary cardiac surgery centre during the period of January and September 2024. One hundred and twenty adult patients (n=120) who had already undergone post-cardiac surgery were included and divided into standard care control (n=60) and multicomponent nursing intervention (n=60) groups. The intervention package included periodic CAM-ICU delirium assessment every 8 hours, reorientation procedures, sleep hygiene, early movement, sensory optimization, family involvement, pain/ sedation management, cognitive stimulation, hydration and nutrition, and daily medication review. The main event was the incidence of delirium according to CAMICU. Secondary outcomes were the duration of delirium, ICU stay, mechanical ventilation stay, antipsychotics, physical restraint, and 30-day readmission.

Results: The occurrence of delirium was greatly reduced in the intervention group as opposed to controls (23.3% vs. 46.7%; p<0.01). Delirium duration was also markedly reduced (1.3±0.9 vs. 2.8±1.6 days; p<0.001). ICU length of stay (4.7±2.1 vs. 6.4±2.9 days; p=0.001), mechanical ventilation duration (15.6±9.3 vs. 22.4±14.8 hours; p=0.003), antipsychotic use (15.0% vs. 33.3%; p=0.02), and physical restraint (10.0% vs. 25.0%; p=0.03) were all significantly reduced in the intervention cohort. Independent risk factors for delirium included age ≥70 years (OR 3.7), prior cognitive impairment (OR 4.4), cardiopulmonary bypass duration ≥90 minutes (OR 3.2), and benzodiazepine use in the ICU (OR 3.4).

Conclusion: A multicomponent, structured nursing intervention bundle has a significant impact on reducing the occurrence and length of stay of delirium in CSICU patients. The use of systematic nursing-based assessment and prevention procedures must be included as a routine practice in cardiac surgery intensive care units.

Keywords: Delirium; Cardiac Surgery; Intensive Care Unit; Nursing Interventions; CAM-ICU; ABCDE Bundle; Postoperative Care; Critical Care Nursing

Citation

Adeel Asghar. Role of Nursing Interventions in Preventing Delirium in the Cardiac Surgery Intensive Care Unit: A Prospective Cohort Study. WebLog J Nurs. wjnr.2026.i1203. https://doi.org/10.5281/zenodo.22839985