Comparative efficacy of non-pharmacological interventions for anxiety in adult intensive care unit patients: A systematic review and network meta-analysis

Background: The primary goal of the intensive care unit is to the anxiety of conscious patients is often ignored in the care unit. Aim: The purpose of this study was to assess the efficacy of various non-pharmacological therapies for anxiety disorders in adult patients in the intensive care unit, in order to enhance humanistic care in the intensive care unit and to promote the patients' physical and mental recovery together. Study Design: We conducted a systematic and comprehensive search of the literature in five databases (including the Cochrane Library, PubMed, EBSCO, Web of Science, and Embase) covering nearly a decade for randomized controlled trials of non-pharmacological therapies to reduce anxiety in adult intensive care unit patients. Two researchers independently assessed the quality of the literature, collected and condensed the data, and used STATA software to perform a network meta-analysis. The ranking probabilities for each intervention were calculated using the Surface under the Cumulative Ranking (SUCRA) method. The study protocol was registered with PROSPERO. Results: This study ultimately included 26 randomized controlled trials involving 2791 adult ICU patients. Non-pharmacological interventions for anxiety in adult ICU patients included music therapy, aromatherapy, ICU diary, virtual reality, massage therapy, monitoring room diary, and health education. when compared to the control group (usual care), aromatherapy + music therapy [MD =-2.65, 95% CI (-4.76,-0.54)] (P = 0.0137) and music therapy [MD =-1.77, 95% CI (-3.40,-0.13)] (P = 0.0338) were superior in reducing anxiety in adult ICU patients. The results of the network meta-analysis showed that aromatherapy combined with music therapy significantly alleviated anxiety in adult ICU patients (SUCRA: 99.8%). Conclusions: Music therapy combined with aromatherapy has demonstrated superior effectiveness compared to other non-pharmacological interventions for reducing anxiety in awake adults in the ICU. However, the underlying mechanisms of this combined therapy require further exploration. Relevance to Clinical Practice: Future research on the use of music therapy combined with aromatherapy in the care unit may help reduce anxiety in patients while fostering their physical and mental healing; however, individual variances and unique clinical circumstances must be considered.