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Updated: Jun 16, 2026
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Comparative effectiveness of non-pharmacological interventions on health-related quality of life in ICU patients: a
Wenhui Yu1,2,3, Lei Huang3,4, Dan Lv1,3
1Department of Intensive Care Medicine, Tianjin University Central Hospital/Tianjin Third Central Hospital, Tianjin, China.
Background:
Intensive care unit (ICU) patients often experience long-term physical and psychological impairments that reduce health-related quality of life (HRQoL). Non-pharmacological interventions (NPIs) are increasingly used, but their comparative effectiveness remains uncertain.
Objective:
To systematically evaluate NPIs for improving HRQoL in ICU patients using a network meta-analysis (NMA), following PICOS and PRISMA-NMA guidelines.
Design:
Systematic review and NMA with a pre-registered protocol (PROSPERO: CRD42024626250).
Methods:
We searched PubMed, Embase, Cochrane Library, Web of Science, and EBSCO to November 2024 for randomized controlled trials enrolling adult ICU patients, comparing NPIs with usual care, placebo, or other NPIs. Eligible studies reported validated HRQoL outcomes (SF-36, SF-12, or EQ-5D). Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. NMA was conducted using RevMan 5.3 and Stata 17.0. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated, and interventions were ranked by surface under the cumulative ranking curve (SUCRA). Only published, peer-reviewed data were included.
Results:
Nineteen RCTs (2,654 patients, 12 NPIs) met inclusion criteria. For overall HRQoL, ICU diary (SMD: -0.30; 95% CI: -0.71-0.10), cognitive therapy plus mobile application (APP+CT) (SMD: -0.26; 95% CI: -0.85-0.33), and electrical muscle stimulation plus physical activity (EMS + PA) (SMD: -0.06; 95% CI: -0.72-0.59) showed the highest SUCRA probabilities. For physical component summary (PCS), the ABCDE bundle (SMD: -0.50; 95% CI: -1.61-0.60) and structured PA (SMD: 0.08; 95% CI: -0.89-1.06) ranked highest. For mental component summary (MCS), the ABCDE bundle (SMD: -0.43; 95% CI: -1.33-0.46) and application-based cognitive therapy (SMD: -0.18; 95% CI: -0.92-0.55) had the greatest probability of benefit. However, none reached statistical significance, as all confidence intervals crossed zero; SUCRA rankings reflect relative probability rather than confirmed effectiveness.
Conclusion:
This NMA found no intervention with statistically significant superiority. ICU diary and the ABCDE bundle appear most promising, yet findings must be interpreted cautiously. Further high quality, multicenter RCTs are needed to validate these results and assess long term outcomes.
Systematic Review Registration:
PROSPERO registration number: CRD42024626250. URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024626250.
