Pilot and Feasibility Study of a Mirrors Intervention for Reducing Delirium in Older Cardiac Surgical Patients

NHS Foundation Trust

Status: Completed

Conditions: Postoperative Delirium

Treatments: Other: Mirrors Intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT01599689

SA16/0212 (Other Grant/Funding Number)

P01629

Details and patient eligibility

About

This pilot cluster-randomised controlled trial aims to determine whether the use of bedside mirrors, as a clearly defined part of patients' postsurgical ICU care, can reduce delirium and improve outcomes in the older cardiac surgical patient.

Full description

The risk of delirium, an acute disturbance in mental status and cognition that occurs commonly after cardiac surgery, increases sharply from the age of about 65 years. Its occurrence, even for one day, is associated with longer ICU and hospital stays, increased costs, and negative physical and cognitive outcomes at one year. In spite of previous prevention and intervention research, delirium incidence in the older cardiac surgical patient remains high (up to 72%).

ICU clinicians at Papworth Hospital have made observations suggesting that delirium could be reduced using a novel and unconventional strategy of bedside mirrors. Mirrors of any type are uncommon in ICU environments[1], but their occasional use by patients on our ICU has been reported by bedside clinicians and physiotherapists to result in:

• a normalisation of mental status and attention (core delirium diagnostic criteria), and
• earlier physical mobilisation (associated with reduced delirium risk), particularly in older-aged patients

Evidence from other sources supports mirrors' beneficial effect in these areas [2-10], but mirror use has never to our knowledge been explored for the reduction of delirium. This pilot study seeks to determine whether the use of bedside mirrors, as a clearly defined part of patients' postsurgical ICU care, can reduce delirium and improve outcomes in the older cardiac surgical patient.

Enrollment: 223 patients

Sex: All

Ages: 70+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• scheduled for elective or urgent cardiac surgery at Papworth Hospital
• aged 70+ years

Exclusion criteria

• inability to obtain informed consent
• care pathway anticipating admission elsewhere than to ICU following surgery
• severe visual impairment impeding ability to recognise self in mirror
• physical or communication barriers likely to impede effective administration of study procedures
• severe mental disability likely to impede effective administration of study procedures or assessment of delirium
• history of psychiatric illness previously requiring hospitalisation

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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223 participants in 2 patient groups

Mirrors Intervention

Experimental group

Description:

Patients allocated to Mirrors will receive a structured, protocol-driven bedside mirrors intervention as part of their postsurgical ICU care. This intervention will commence as soon as all anaesthetic agents have been switched off and the patient is awake following surgery unless considered clinically inappropriate.

Treatment:

Other: Mirrors Intervention

Standard Care

No Intervention group

Description:

Patients allocated to Standard Care will receive the usual postsurgical ICU care that does not include the use of mirrors.