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

Xing Shu; Shuang Li; Zewen Pan; Hao Peng; Jiayi Zhou; Can Wang; Mingfang Xiang

doi:10.1016/j.ijnurstu.2025.105245

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

Int J Nurs Stud. 2026 Jan:173:105245. doi: 10.1016/j.ijnurstu.2025.105245. Epub 2025 Oct 10.

Authors

Xing Shu¹, Shuang Li², Zewen Pan³, Hao Peng¹, Jiayi Zhou⁴, Can Wang¹, Mingfang Xiang⁵

Affiliations

¹ School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
² Department of Head and Neck Lymphoma, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University Of Electronic Science and Technology of China, Chengdu, China.
³ Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University Of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Emergency, Sichuan Province Forestry Center Hospital, Chengdu, China.
⁵ Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University Of Electronic Science and Technology of China, Chengdu, China. Electronic address: xmf429@126.com.

PMID: 41109065
DOI: 10.1016/j.ijnurstu.2025.105245

Abstract

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.

Keywords: Intensive care unit; Network meta-analysis; Non-pharmacological interventions; Thirst.

Publication types

Systematic Review
Network Meta-Analysis

MeSH terms

Humans
Intensive Care Units*
Randomized Controlled Trials as Topic
Thirst*