Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults : a systematic review and network meta-analysis

Background: Delirium presents a serious health problem in critically ill patients in intensive care units. However, knowledge regarding the selections of the optimal non-pharmacological interventions remains unclear. Objectives: To compare the effects of non-pharmacological interventions by combining direct and indirect evidence on the incidence and duration of delirium in intensive care units. Design: A systematic review and network meta-analysis. Data sources: A comprehensive search of five electronic databases, including PubMed, EMBASE, CINAHL, Cochrane CENTRAL, and ProQuest Dissertations and Theses A&I were conducted. Only randomized control trials published from the inception to December 28, 2021 were included. Review methods: Two reviewers independently screened the title and abstract for eligibility according to the inclusion and exclusion criteria. The random-effect network meta-analysis was used to estimate the comparative effects of non-pharmacological interventions in reducing delirium incidence and duration. Results: A total of 29 studies with 7005 critically ill patients were enrolled. Twenty-six and eleven studies reported the delirium incidence and duration, respectively. Component-based intervention comparison revealed that multicomponent strategy was the most effective non-pharmacological intervention compared to usual care in reducing incidence of ICU delirium (Odd ratio [OR]=0.43, 95% CI= 0.22–0.84) but not ICU delirium duration. Treatment-based intervention comparisons indicated that specific multi-treatment interventions significantly reduced the ICU delirium incidence and duration, particularly the involvement of early mobilization and family participation (OR = 0.12 with 95% CI = 0.02 to 0.83; mean difference = -1.34 with 95% CI = -2.52 to -0.16, respectively). Conclusion: Our study suggests that the multicomponent strategy was the most effective non-pharmacological intervention in reducing the incidence of ICU delirium. Early mobilization and family participation involvement in non-pharmacological interventions seemed to be more effective in reducing the incidence of ICU delirium. These results of network-meta analysis could be an important evidence-based for clinical healthcare providers to optimize the critical care protocol.