Familiar voices help reduce the risk of delirium in ICU patients

The innovative use of recorded messages from a family member to provide reorientation information to a critically ill patient receiving mechanical ventilation helped reduce the risk of developing delirium, according to new research published in American Journal of Critical Care (AJCC).

"Delirium Reduction via Scripted Family Voice Recordings in Critically Ill Patients Receiving Mechanical Ventilation" details a rigorous, structured intervention called Family Automated Voice Recording (FAVoR), which played recorded messages from family members on an hourly basis during the daytime to promote day-night orientation.

Patients in the FAVoR intervention group had a higher rate of delirium-free days than patients in the control group who received usual care. The results also suggest a dose-response relationship between the number of times the messages played and the number of delirium-free days.

Lead author Cindy Munro, PhD, RN, ANP-BC, is dean emeritus, University of Miami School of Nursing and Health Studies, Coral Gables, Florida. She shared key takeaways from the study in a video interview that accompanies the journal article.

The evidence has long shown that family involvement is a key element in delirium prevention and interventions, but families often face challenges to fully participating in their loved ones' care. We designed this intervention to augment family presence so that a patient could hear from a loved one, even if their family wasn't able to physically be at the bedside."

Cindy Munro, PhD, RN, ANP-BC, lead author

Delirium is one of the most frequent complications for patients in intensive care units (ICUs) and is associated with adverse short-term and long-term outcomes. Most research on reducing the incidence and severity of delirium has focused on detection of its onset and evaluation of pharmacological interventions (none of which have been shown to be effective).

The prospective, two-arm, blinded, randomized controlled trial with 178 adult patients was conducted in nine ICUs at two large hospitals in South Florida between April 2018 and November 2020, with a three-month pause in spring 2020 due to COVID-19 pandemic-related restrictions. This clinical trial is the first to test the concept and provide high-quality evidence to support its effectiveness as a simple, low-cost and easy-to-implement nonpharmacological intervention.

The series of 10 two-minute recordings were uploaded to a wireless speaker placed near the patient's ear and set to play automatically once an hour during daytime waking hours for a maximum of five days. The standardized, scripted messages were recorded in either English or Spanish by a family member selected by the patient's family.

Messages included general information describing the ICU environment, presence of visual and auditory stimuli, and the presence of healthcare professionals and family members. 

Outcome assessors used the Confusion Assessment Method for the ICU-7 (CAM-ICU-7) to measure delirium for all study participants twice daily, before the first message of the day played and after the last one. Wireless speakers were placed on all patients' bedsides to mask their group assignment to the assessors.