背景：谵妄与亚谵妄综合征是症状群相同、危险因素相似的急性脑功能障碍综合征，在重症监护室中发生率高，对患者造成不同程度的不良影响，增加医疗费用和卫生保健系统负担。目前药物效果尚未得到证实，且存在不良反应，因而主要集中于应用多元非药物措施对可调节危险因素的纠正与控制。然而，目前临床谵妄和亚谵妄综合征管理不足，与缺乏相关证据进行指导有关，而相关研究中推荐意见和干预方案可能不尽相同，有必要对谵妄和亚谵妄综合征的多元非药物管理证据进行分析和总结。通过基于知识转化（Knowledge To Action）模式构建的KTA证据总结流程结合JBI证据预分级及证据推荐级别系统，能增加证据总结过程的透明度和规范性，并为后续证据应用提供连续性和科学性依据。

目的：通过KTA证据总结和JBI证据分级系统，提取、总结成人危重患者谵妄和亚谵妄综合征非药物管理相关证据。

方法：以加拿大知识转化框架中的证据总结流程与JBI证据预分级和证据推荐级别作为指导，通过检索和筛选各大英文数据库Pubmed、Embase、CINAL和中文数据库万方、中国知网、SinoMed，各大指南网站G-I-N、WHO、NICE、RNOA、SIGN、MINDS、ACPG、JBI、Cochrane和医脉通指南网，相关协会网站AGS、ADS、BGS、EDA、AWMF、ANZSGM，和临床试验注册网站ICTRP、Cochrane CENTRAL中符合发表年限、目标人群和研究类型等要求的文献，通过阅读参考文献扩大范围进行补充检索，对符合纳入标准的文献进行质量评价，剔除质量评价不通过者，最终纳入的文献进行证据提取、证据分级和推荐分级，形成成人危重患者谵妄与亚谵妄综合征多元非药物管理证据总结。

结果：经检索筛查后纳入52篇文献，根据质量评价结果纳入47篇文献进行证据综合，共进行证据提取和综合出包括谵妄风险预测、筛查、预防和治疗等证据和推荐意见共47条。

结论：本研究通过综合证据，总结出谵妄和非药物多元非药物管理推荐建议，对现有的证据总结进行了综合和完善，后续可尝试据此构建临床实践方案，以促进知识转化、优化谵妄管理、改善临床结局。

Background: Delirium and Subsyndrome Delirium are acute brain dysfunction syndromes with the same symptom and similar risk factors. Both of them have high incidence in ICU, causing adverse effects and are becoming a great burden of health care system. predicting, screening, preventing and treating delirium and SSD have become the key indicators and factors of the quality of care in ICU for the last couple years. While pharmacological options are not suggested, researchers have been dedicated to reveal whether multicomponent nonpharmacological interventions focusing on the adjustable risk factors benefit. However, recommendations and research outcomes differ. Evidence which comprehensively summarize validated evidence are lack and necessary. Transparency and validity of evidence summary process can be increased within the combination of Knowledge to Action model’s evidence summary process and Joanna Brigges Institute’s evidence pre-ranking and evidence recommendation system. Thus to form a continuity and scientific basis for knowledge translation and delirium management.

Objectives: Summarizing the relevant evidence of non-pharmacological management of delirium and Subsyndromal delirium for critically ill adults, through KTA evidence summary and JBI evidence classification system, thus to promote knowledge translation, optimize delirium management and improve patient outcome.

Methods: The evidence summary process in this research was guided by the evidence summary process and JBI evidence pre classification and evidence recommendation system. We searched and selected articles via English websites of guidelines and related societies such as G-I-N, WHO, NICE, RNAO, SIGN, MINDS, ACPG, Yimaitong and AGS, ADS, BGS, EDA, AWMF, ANZSGM. As well as databases like JBI, PubMed, EMBASE, Wanfang Data, CNKI, Sinomed, and clinical trial registration website ICTRP, Cochrane CENTRAL. Grey literature was searched so as references in included articles to expand the searching scope. After including articles that meet the inclusion critiria of publication year, target population and research type, 3 researchers independently appraisal the articles using validated tools. And qualitative evidence synthesis was formed to implicated the best practice of nonpharmacological management of delirium and subsyndromal delirium in adult critically ill adult patients.

Results: A total of 52 documents were included, and the evaluation results showed that the quality of the included documents was high. 47 pieces of evidences and recommendations including delirium risk prediction, screening, prevention and treatment were generated.

Conclusions: Based on the evidence summary process, the evidence summary for nonpharmacological management of delirium and subsyndromal delirium is of scientific and feasible, which can later be imported to clinical practice to further verify in both effectiveness and cost-effectiveness.