Effectiveness of non-pharmacological interventions for relieving thirst in intensive care unit patients: A network meta-analysis

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.