Design: Bayesian network meta-analysis of randomised trials
Population: 21 trials of ICU patients with delirium
Primary outcome: Delirium cure rate, ICDSC and APACHE II scores
Effect: No intervention significantly better than regular nursing (all P>0.05)

A Bayesian network meta-analysis of 21 randomised trials compared nursing interventions for delirium in intensive care: auricular acupressure, music, cognitive exercises, longer visiting hours and targeted nursing, each against regular nursing.

None differed significantly from regular nursing for delirium resolution, delirium screening scores or illness severity scores. Rankings placed acupressure and music highest, but the authors note that rankings show relative order, not proven benefit.

The practical reading is that no single add-on has shown it can replace the established basics: reorientation, sleep, early mobilisation, family presence and avoiding deliriogenic drugs.

No single nursing add-on has proven superior to good usual care for ICU delirium
Do not read treatment rankings as proof of benefit
Keep the established bundle: reorientation, sleep, mobilisation and minimal sedation
Flexible visiting is a reasonable, low-cost part of delirium care

Why it matters

It cautions against adopting a fashionable add-on in place of basics that are already known to matter.

The statistics, in plain English

In a network meta-analysis, ranking first means an intervention looked best on average, but when no comparison is statistically significant, the ranking may be noise.