A Systematic Meta-Review of Interventions to Prevent and Manage Delirium in the Intensive Care Unit: Part 2 - Non-Pharmacological and Multicomponent Interventions
Critical Care
Kundakci, B., Jones, K., et al. (2025).
Critical Care, 29(1), 501.
<div>This scoping review investigates the effects of non-pharmacological and multicomponent interventions on outcomes for individuals with delirium in the Intensive Care Unit (ICU). </div>
Not stated
From 2000 to August 2025
<div>Systematic reviews and meta-analyses</div>
19
<div>Non-pharmacological interventions reduced risk of delirium as follows:</div>
<div>
<ul>
<li>the ABCDEF bundle (Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials and Spontaneous Breathing Trials, Choice of analgesia and sedation, Delirium: Assess, Prevent, and Manage, Early mobility and Exercise, and Family engagement and empowerment bundle) nearly halved delirium risk (RR = 0.57);</li>
<li>multicomponent interventions also significantly reduced occurrence (OR = 0.48);</li>
<li>early mobilization was more effective than usual care in preventing ICU delirium (OR = 0.53) and reduced the odds of delirium by just under 70% (OR = 0.33);</li>
<li>Family-based interventions reduced delirium risk by more than half (RR = 0.46); though</li>
<li>playing a recorded family voice alone was not effective to reduce delirium risk.</li>
</ul>
<div>Limitations to this review included heterogeneity of interventions included across multicomponent interventions and overall low quality evidence of the included studies. </div>
</div>
<div>Non-pharmacological interventions may reduce duration of delirium as follows:</div>
<div>
<ul>
<li>the ABCDEF bundle reduced delirium duration by around 1.4 days compared with usual care (MD = −1.37);</li>
<li>multicomponent interventions similarly shortened delirium by about 1.5 days (MD = −1.47);</li>
<li>early mobilization reduced delirium duration by nearly two days (MD = −1.78);</li>
<li>family interventions reduced delirium duration by just over two days (WMD = −2.18); while</li>
<li>approaches limited to photos or recorded voices did not show significant benefit.</li>
</ul>
<div>Limitations to this review included heterogeneity of interventions included across multicomponent interventions and overall low quality evidence of the included studies. </div>
</div>
<div>Non-pharmacological interventions may reduce ICU length of stay (LOS) as follows:</div>
<div>
<ul>
<li>the ABCDEF bundle reduced hospital LOS by around 1.5 days (MD = −1.47) in one study but another did not show a significant effect on ICU LOS;</li>
<li>multicomponent non-pharmacological interventions were associated with a one-day reduction in ICU LOS (MD = −1.01);</li>
<li>family participation interventions reduced ICU LOS by about 1.5 days (MD = −1.46); though</li>
<li>early mobilization did not demonstrate a significant reduction in LOS.</li>
</ul>
<div>Limitations to this review included heterogeneity of interventions included across multicomponent interventions and overall low quality evidence of the included studies. </div>
</div>
<div>Multicomponent interventions potentially reduced ICU mortality compared to controls(OR = 0.51), while no statistical difference was found for the ABCDEF bundle or for family interventions. Limitations to this review included heterogeneity of interventions included across multicomponent interventions and overall low quality evidence of the included studies. </div>
