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Multicomponent non-pharmacological interventions for preventing delirium in critically ill patients: a systematic
Shiting Wang1,2, Jiamin Lei1,2, Wenjing Huang1,2
1The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China.
Background:
It is necessary to evaluate the efficacy of multicomponent non-pharmacological interventions in preventing and managing intensive care unit (ICU) delirium and identify the most effective intervention combinations.
Methods:
A systematic literature search was conducted in PubMed, EMBASE, CINAHL, Cochrane Library, and ProQuest Dissertations and Theses A&I databases from inception to July 3, 2026, supplemented by a hand search of prior meta-analyses. Only randomized trials were included. Meta-analysis was performed using risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). Random-effects models with restricted maximum likelihood estimation and modified Hartung-Knapp confidence intervals were used. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized controlled trials. The certainty of evidence was assessed using the GRADE approach.
Results:
The search identified 13 randomized controlled trials encompassing 5,525 patients. Multicomponent interventions significantly reduced delirium incidence (RR 0.53, 95% CI [0.36, 0.76], I2 = 72.5%, low-certainty evidence). The effect remained significant after excluding the two cluster-randomized trials (RR 0.45, 95% CI 0.30-0.67; I2 = 55.7%), the active-control trial (RR 0.55, 95% CI 0.38-0.79; I2 = 73.0%), and all three trials simultaneously (RR 0.46, 95% CI 0.31-0.70; I2 = 57.0%). In exploratory subgroup analysis, the within-subgroup pooled estimate for component pattern B, comprising cognitive assessment and stimulation, reorientation, sleep and environmental management, family or community support, and physical activity, showed a reduced incidence of delirium (RR 0.43, 95% CI [0.23, 0.82]); however, the formal test for subgroup differences was not significant (p = 0.604). No statistically significant effects were found for delirium duration, ICU or hospital length of stay, delirium-free days, or mortality.
Conclusion:
This study demonstrated that multi-component interventions effectively reduce delirium incidence in critically ill patients. The evidence did not establish that one component combination was superior to another.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024592821.