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The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis

  • Leona Bannon
  • Jennifer McGaughey
  • Rejina Verghis
  • Mike Clarke
  • Daniel F. McAuley
  • Bronagh Blackwood
Systematic Review

Abstract

Purpose

To evaluate the effect of non-pharmacological interventions versus standard care on incidence and duration of delirium in critically ill patients.

Methods

We searched electronic and grey literature for randomised clinical trials up to March 2018. Two reviewers independently screened, selected and extracted data. Meta-analysis was undertaken using random effects modelling.

Results

We identified 15 trials (2812 participants). Eleven trials reported incidence of delirium. Pooled data from four trials of bright light therapy showed no significant effect between groups (n = 829 participants, RR 0.45, 99% CI 0.10–2.13, P = 0.19, very low quality evidence). Seven trials of various individual interventions also failed to report any significant effects. A total of eight trials reported duration of delirium. Pooled data from two trials of multicomponent physical therapy showed no significant effect [n = 404 participants, MD (days) − 0.65, 99% CI − 2.73 to 1.44, P = 0.42, low quality of evidence]. Four trials of various individual interventions also reported no significant effects. A trial of family voice reorientation showed a beneficial effect [n = 30, MD (days) − 1.30, 99% CI − 2.41 to − 0.19, P = 0.003, very low quality evidence].

Conclusions

Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients. Future research should consider well-designed and well-described multicomponent interventions and include adequately defined outcome measures.

Keywords

Critical care Delirium Meta-analysis Non-pharmacological interventions Systematic review 

Notes

Acknowledgements

The authors acknowledge Mrs Patricia Watt, Mrs Brenda Allen and Mr Richard Fallis from Queen’s University Belfast medical library for their invaluable help in developing a search strategy and locating full text of manuscripts. The authors also thank E. Alvarez, R. Simons, L. Denehy, P. Black and C. Smith for providing additional information on their studies. This work was funded by a Doctoral Fellowship Award to LB by the Northern Ireland Health and Social Care research and development division. Funding was provided by Public Health Agency (Grant no. EAT/5092/14).

Compliance with ethical standards

Conflicts of interest

The lead author (LB) has been paid an honorarium for a presentation on non-pharmacological interventions for delirium management in critically ill patients by Orion Pharmaceuticals. Other authors report no conflict of interest.

Supplementary material

134_2018_5452_MOESM1_ESM.docx (96 kb)
Appendix A: Search strategy. Appendix B: Data extraction form. Appendix C: Summary table of characteristics of included studies. Appendix D: List of excluded studies. Appendix E: List of unclassified studies. Appendix F: Risk of bias within studies (DOCX 95 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Leona Bannon
    • 1
  • Jennifer McGaughey
    • 2
  • Rejina Verghis
    • 1
  • Mike Clarke
    • 3
  • Daniel F. McAuley
    • 1
  • Bronagh Blackwood
    • 1
  1. 1.School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental MedicineQueen’s University BelfastBelfastUK
  2. 2.School of Nursing and MidwiferyQueen’s University BelfastBelfastUK
  3. 3.Centre for Public Health, School of Medicine, Dentistry and Biomedical ScienceQueen’s University BelfastBelfastUK

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