Non-pharmacological interventions on the prevention of delirium in patients under open heart surgery: A narrative review

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    Marzieh Azizi 1, Fatemeh Alizadeh Arimi 2, Forouzan Elyasi *3

    1 Ph.D. Student of Reproductive Health, Department of Midwifery and Reproductive health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Email:

    2 Psychiatric Resident, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Email:

    *3. Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. E mail:


    Introduction and aim: Delirium is fluctuating, acute, and multifactorial condition leading to mental confusion, altered level of consciousness and declined cognitive level. It affects 15-70% of the medical and surgical population under open heart surgery admitted to intensive care units. Prevention of delirium is clearly desirable for both patients and healthcare professionals, and can also reduce the health service costs. A range of non-pharmacological interventions for preventing delirium in hospitalized patients have been developed. This study aimed to assess the non-pharmacological interventions on the prevention of delirium in patients under open heart surgery.

    Methods: The present study is a review in which researchers conducted their computer search in database such as Google Scholar, ScienceDirect,, Web of Science, PubMed and Scopus with using text word and medical Subject Heading (MesH) methods with key words such as [(“non-pharmacological interventions” OR “non-pharmacological strategies” OR “psychological interventions”) AND (“delirium” OR ” acute confusion state) AND (“open heart surgeries” OR “heart surgery”)]. As a result of search process, 40 articles were extracted from 1995-2020. Articles were excluded if they were written in languages other than Persian or English or were irrelevant to the topic. The abstract of all retrieved articles were read and screened and ultimately, we used 31 full text articles to write this review study.

    Results: Among studies showed that there are different non-pharmacological strategies to prevent the delirium in patients under heart surgeries. Results were classified in three main categories. Physical interventions (such as counteraction of immobilization, range of motion exercises, multicomponent physical therapy, multicomponent intensive occupational therapy including positioning, physical rehabilitation, paired awakening and breathing, avoidance of sensory deprivation (glasses, denture and hearing aids)), environmental interventions (such as bright light therapy, environmental manipulation, inserted familiar objects in the room such as clock and calendar), psychosocial intervention (such as systematic cognitive screening, multicomponent orientation and cognitive stimulation and training, cognitive-behavioral methods, relative involvement such as reorientation using family voice and family supportive reorientation, daily proactive geriatrics consultation, progressive muscle relaxation, relaxing breathing techniques, (self) hypnosis, guided imagery or autogenic training, psychoeducational interventions, music therapy and singing).

    Conclusion: Given the possibility of delirium incidence in patients under the heart surgery is relatively high, so considering multicomponent interventions such as multicomponent non-pharmacological in the therapeutic planning may be useful in preventing of the delirium in these patients.

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