Non-pharmacological delirium care in ICU: a systematic review

Abstract

Background: Delirium is a frequent and serious complication in critically ill patients, particularly in intensive care units (ICUs). It is associated with prolonged hospital stays, increased morbidity, and long-term cognitive impairment. Non-pharmacological interventions are considered safe alternatives to pharmacological treatments and align with principles of person-centered care. The aim of this review is to evaluate and synthesize evidence on the effectiveness of non-pharmacological interventions in preventing and managing delirium in critically ill adult ICU patients. Methods: A systematic review was conducted using PubMed, Web of Science, and the Cochrane Library. Included studies assessed non-pharmacological interventions in adult ICU patients, reporting on delirium-related outcomes. Thematic synthesis and quality appraisal using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework were performed. Results: Multicomponent interventions— particularly ABCDE/ABCDEF bundles—were most consistently effective in reducing delirium incidence and duration. Early mobility and structured physical activity showed positive effects when implemented early and consistently. Family engagement interventions, especially structured visitation and reorientation, were also effective. Other strategies, including cognitive stimulation, music therapy, and environmental modifications, showed mixed results. The quality of evidence ranged from low to high. Conclusions: Non-pharmacological interventions, especially when multicomponent and protocol-driven, are effective in managing delirium in critically ill patients. Their integration into ICU practice can reduce the delirium burden and improve patient outcomes. The PROSPERO Registration: CRD420251151545.