Summarising the Best Evidence for Non-Pharmacological Prevention of Delirium in Mechanically Ventilated ICU Patients.

BACKGROUND

Delirium is a significant concern for mechanically ventilated patients in intensive care units. Non-pharmacological strategies may help prevent delirium, but without a standard protocol, interventions are inconsistent.

AIM: This study assessed existing evidence on non-pharmacological interventions for decreasing delirium in mechanically ventilated ICU patients.

STUDY

DESIGN

We applied evidence summary reporting standards and the '6S' pyramid model, searching key databases and webpages with a top-down focus on high-level evidence about non-pharmacological delirium prevention. The search covered literature published up until March 13, 2025.

RESULTS

Eighteen documents were included: two guidelines, three expert consensuses, seven systematic reviews, three randomised controlled trials and three clinical decision analyses. The integrated evidence was grouped into six domains: assessment and diagnosis, positive internal experience, environment control, physical function recovery, traditional Chinese medicine (including five-animal play, five-element music therapy and acupuncture) and bundled interventions. This resulted in the development of 26 evidence-based recommendations-20 Grade A (strong recommendation) and six Grade B (weak recommendation), indicating a high degree of consensus and clinical feasibility.

CONCLUSIONS

We synthesised 26 of the highest-quality studies from six domains to generate a comprehensive framework for non-pharmacological delirium prevention in mechanically ventilated ICU patients. These evidence-based suggestions provide practical clinical advice that healthcare professionals can adapt based on local resources and clinical contexts to guarantee safety and efficacy.

RELEVANCE TO CLINICAL PRACTICE: This study reviewed the best evidence for the non-pharmacological prevention of delirium in mechanically ventilated ICU patients, from which it derived a comprehensive framework for clinical practice. This framework can reduce the frequency and length of delirium episodes, improve patient health outcomes and improve overall nursing quality.

REGISTRATION: This review was submitted by Fudan University's Evidence-Based Nursing Center with registration number ES20246510.