Effect of nonpharmacological interventions for the prevention of delirium in the intensive care unit: A systematic review and meta-analysis

We aimed to classify nonpharmacological interventions used for preventing delirium in the intensive care unit (ICU), and estimate their effect size. In this systematic review and meta-analysis, the literature was searched and studies were selected based on the PRISMA flow chart. Data sources included MEDLINE, Cochrane, CINHAHL, PsyInfo, and EMBASE. We used Cochrane's Effective Practice and Organisation of Care (EPOC) criteria in study design and quality assessment of the meta-analysis. This systematic review and meta-analysis included 35 and 15 studies, respectively. Studies were grouped into nine intervention types: multicomponent (16 studies), physical environment (9), daily interruption of sedation (2), exercise (2), patient education (2), automatic warning system (1), cerebral hemodynamics improving (1), family participation (1), and sedation reducing protocol (1). The effect size of preventive nonpharmacological interventions had an odds ratio (OR) of 0.66 (95% confidence interval [CI], 0.50–0.86) for delirium occurrence, and an OR of 0.31 (95% CI, 0.10–0.94) for delirium duration. Although relevant studies by interventions were lacking, a partial subgroup analysis by intervention was performed. Nonpharmacological interventions were effective in reducing the duration and occurrence of delirium. Consistent application and development of nonpharmacological interventions for use in the ICU are important.