Table 2 Non-pharmacological delirium interventions

Education

 Delirium prevention toolkit & PICU journal

Silver and Traube (2019) [45]

The toolkit contained a pamphlet to educate the family about delirium

To promote sleep, they included an eye mask to help eliminate light and headphones to reduce noise. The patients were encouraged to document their stay in a notebook (PICU Journal) to minimize PTSD

 Health professional education

Rohlik et al. (2018) [30]

Education included information on general PD principles, delirium management strategies, and pCAM-ICU use

 Pre-operative visit

Zhong et al. (2018) [31]

Children and parents visited the waiting area, operation room, and recovery room

Pre-operative visit education encompassed the operation process, instruments, induction, and recovery process

 Pre-operative preparation workshop

Hilly et al. (2015) [50]

Pre-operative education workshop explained the operation process, induction, and recovery process. Children became accustomed to the operating room using a scale model, Playmobil

 Video-based PPIA preparation

Bailey et al. (2015) [29]

Parent education included what to expect in the OR, the role of parents, and the relationship between parental anxiety and children’s outcomes in the OR

Multicomponent

 PAD bundle

Cloedt et al. (2022) [43]

Assessments of pain and agitation were completed every 4 h

Delirium screening was completed at 8–12 h using the CAPD

Withdrawal assessment was performed every 12 h using the WAT-1

 BED intervention

Rohlik et al. (2021) [44]

Day and night cycle was normalized, patients were oriented to their surroundings, and early

mobility was promoted. The following were ensured in the study: provision of a familiar environment, avoidance of sensory over- or under-stimulation, and optimization of sleep

BED paper checklists were created and placed in the patient’s room

 BED bundle with noise pollution reduction

Kawai et al. (2019) [46]

Thirty-five sound sensors were installed in the patients’ bed spaces, hallway, and common area. The pediatric delirium bundle was implemented for over 28 days

 ICU bundle

Simone et al. (2017) [48]

Delirium screening, prevention, and treatment: delirium screening using CAPD. Nurses and physicians were educated about CAPD. Monthly inter-professional case conferences increased delirium awareness. Sedation and early mobilization protocols were implemented

 Video distraction and parental presence

Kim et al. (2015) [51]

Children watched cartoon videos with their parents throughout the whole anesthesia induction process

 ADVANCE intervention

Kain et al. (2007) [42]

Anxiety reduction, distraction on the day of surgery, video modeling, and education before the day of surgery. Inclusion of parents in the child’s surgical experience, promotion of family-centered care, and no excessive reassurance. Exposure/shaping of the child via induction mask practice

Technology-Assisted

 Music intervention with application use

Garcia Guerra et al. (2021) [33]

The music group received classical music for 30 min three times a day through headphones. A music therapist selected pre-recorded short pieces of classical music

 Unilateral right-side stimulation of HT7 acupuncture point

Nakamura et al. (2018) [47]

Unilateral right-side stimulation of the HT7 acupuncture point using a single twitch electrical stimulus was performed throughout the surgery

 Mother’s voice

Byun et al. (2018) [32]

Song et al. (2017) [34]

At the end of the operation, the recorded mother's voice was played through noise-cancelling headphones

Maternal voice recordings were played repeatedly through headphones in the PACU

 Ultrasound-guided II/IH nerve block

Ohashi et al. (2016) [49]

An anesthesiologist performed an ultrasound-guided nerve block

Once the needle was placed between the internal oblique and transversus abdominus muscles, ropivacaine was injected