Supplementary file 1_Multicomponent non-pharmacological interventions for preventing delirium in critically ill patients: a systematic review and meta-analysis of randomized controlled trials.docx

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.</p>Results<p>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.</p>Conclusion<p>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.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/view/CRD42024592821.</p>