A systematic meta-review of interventions to prevent and manage delirium in the Intensive Care Unit: Part 2 – Non-pharmacological and multicomponent interventions

Background

Intensive Care Unit (ICU) delirium is a multifactorial syndrome associated with prolonged hospitalisation, increased morbidity and mortality, cognitive decline, and higher healthcare costs. Prevention and management of delirium have to date included both pharmacological and non-pharmacological interventions. Many of these interventions have been combined in systematic reviews. This systematic meta-review (Part 2) reviews, details and analyses non-pharmacological and multicomponent interventions to prevent and manage ICU delirium.

Methods

A comprehensive search was conducted across eight databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Scopus, CINAHL, PsycINFO and Web of Science) from their inception until 8th August 2025. Eligible reviews included critically ill adults in ICU settings and examined the effectiveness of non-pharmacological and multi-component interventions on delirium occurrence, mortality, ICU and hospital length of stay (LOS) and other core outcomes. Reviews were assessed for quality using a framework of methodological interpretation of review conduct and reporting.

Results

Thirty-two systematic review and meta-analyses including 335 single studies assessing 16 non-pharmacological interventions were included. The ABCDEF bundle and other multicomponent non-pharmacological interventions and early mobilization significantly reduced delirium incidence and duration. Family participation in care was also reported to reduce delirium incidence. Mortality benefits were reported in studies of multicomponent non-pharmacological interventions. The evidence was inconsistent and often of low quality.

Conclusions

While some non-pharmacological interventions (multi-component care packages, early mobilization and family-based interventions) show potential to reduce delirium occurrence and duration. Multicomponent strategies, particularly those including early mobilization and family participation, appear more effective.