- Design
- Systematic review and 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)
This Bayesian network meta-analysis included 21 randomised trials of nursing interventions for delirium in intensive care: auricular acupressure, music therapy, cognitive exercise, longer visiting hours and targeted nursing, each compared with regular nursing care.
None was significantly better than regular nursing for delirium resolution, delirium screening checklist (ICDSC) scores or APACHE II scores. Acupressure and music ranked highest, but rankings describe relative order, not proven benefit, and the authors say so.
For physicians on wards and in high-dependency units, the lesson is to get the basics right rather than chase add-ons. The established bundle (reorientation, sleep, mobilisation, hearing and vision aids, avoiding deliriogenic drugs, family presence) has stronger evidence than any single intervention here.
- No single nursing add-on was proven better than good standard care for ICU delirium.
- Keep glasses and hearing aids on, reorient often, and protect night-time sleep.
- Review and reduce benzodiazepines, anticholinergics and opioids where possible.
- Longer family visiting is cheap and was promising, though not proven here.
Why it matters
It stops attention drifting from the bundle that works to add-ons that have not shown benefit.
Don't overread it
A top ranking in a network meta-analysis is not evidence of efficacy when no comparison was significant.
The statistics, in plain English
SUCRA rankings order treatments by the probability of being best but do not show that any is actually better than control; here, none was statistically superior. Many included trials were small, which limits precision.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free