Nicholas M, Wittmann J, Norena M, Ornowska M, Reynolds S. A randomized, clinical trial investigating the use of a digital intervention to reduce delirium-associated agitation. NPJ Digit Med. Oct 30 2023;6(1):202. doi:10.1038/s41746-023-00950-4
This randomized clinical trial examined the effectiveness of a novel digital intervention “MindfulGarden” in reducing agitation in patients with delirium. Delirium is an acute neuropsychiatric disorder that is commonly seen in critical care patients. Patients experience cognitive impairment, hallucinations, and bouts of physical aggression, termed agitation. Reducing agitation in patients with delirium without the use of physical or chemical restraints remains a challenge. “Mindful Garden” is a screen-based interactive platform developed to reduce agitation. Seventy patients (Age = 19-89, 70% male) were recruited from the critical care (n = 65) and high acuity cardiac telemetry (n = 5) units of the Royal Columbian Hospital (New Westminster, Canada). In both groups, normal behavioral re-orientation provided by nursing staff continued (i.e., changing clocks, using whiteboards, physiotherapy). In the experimental group, each participant had “MindfulGarden” installed at the foot of their hospital bed for 4 consecutive hours, spanning one nursing shift. Any increasing changes in speech (tone, loudness) or movement (speed, location) by participants induced visual stimuli to move and scenes to change on the “MindfulGarden” screen. The use of MindfulGarden reduced agitation measures (Richmond Agitation Sedation Scale; RASS; 70.6%) compared to care as usual (40%) within the first hour (p = 0.01). This difference between the intervention and control groups persisted across the four-hour block (p = 0.04). Exposure to “MindfulGarden” failed to differentiate control and experimental groups in the proportion of patients who received unscheduled medication for delirium and measures of delirium itself (Intensive care delirium screening checklist; ICDSC, p > 0.05). Further research is needed to explore the benefits of this tool in reducing agitation in other in-patient populations marked by cognitive impairment and distress. Studies with an increased sample size may provide insight into the early, but not sustained decrease of unplanned chemical intervention with the use of “MindfulGarden” compared to control care.