BACKGROUND:Thirst is a prevalent and clinically significant symptom among intensive care unit patients. However, the comparative effectiveness of various non-pharmacological interventions for relieving thirst remains largely unclear.
OBJECTIVES:To evaluate the comparative effectiveness of non-pharmacological interventions for thirst alleviation in intensive care unit patients through a synthesis of direct and indirect evidence.
DESIGN:A systematic review and network meta-analysis.
DATA SOURCES:A comprehensive search of sixteen electronic databases and ClinicalTrials.gov was conducted for randomized controlled trials from inception to November 20, 2024.
REVIEW METHODS:Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. The primary analysis utilized random-effects network meta-analysis to assess the effectiveness of non-pharmacological interventions in reducing thirst intensity. The quality of evidence was assessed using the Confidence in Network Meta-Analysis (CINeMA) online tool. This study was registered in PROSPERO (CRD42024606388).
RESULTS:A total of 14 studies, encompassing 1642 critically ill patients, met the inclusion criteria and evaluated 13 non-pharmacological interventions for thirst alleviation. Compared to routine oral care, the following interventions showed statistically significant efficacy (all P < 0.05), ordered by their surface under the cumulative ranking curve (SUCRA): mint liquid spray (82.4 %), room temperature water spray (82.3 %), menthol lozenge (81 %), lemon liquid spray (78.8 %), drinking a little ice-cold water (65.3 %), and ice-cold water spray (51.3 %). The CINeMA assessment indicated that the overall certainty of the evidence remained low.
CONCLUSIONS:This network meta-analysis suggests that mint liquid spray may appear to offer benefits for relieving thirst among ICU patients, indicating that spray-based moisturization is a promising strategy. We advocate for comprehensive ICU oral care, emphasizing tailored interventions and the integration of low-temperature and menthol adjuncts into standard care protocols. Such strategies may help alleviate thirst-related distress and optimize critical care outcomes. However, further high-quality, standardized studies are required to verify these findings.