• Susan E Thrane, Katie Hsieh, Paige Donahue, Alai Tan, Matthew C Exline, and Michele C Balas.
• The Ohio State University, College of Nursing, Newton Hall, 1585 Neil Avenue, Columbus, OH 43210, United States. Electronic address: thrane.2@osu.edu.
• Complement Ther Med. 2019 Dec 1; 47: 102166.

ObjectiveThe purpose of this systematic review was to critically evaluate the safety and effectiveness of various complementary health approaches (CHAs) in treating symptoms experienced by critically ill adults.MethodsThe review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Electronic databases (PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Center, Medline, PsychInfo) were searched for studies published from 1997-2017. Randomized controlled trials (RCTs), in English with terms ICU/critical care, music, Reiki, therapeutic touch, healing touch, aromatherapy, essential oil, reflexology, chronotherapy, or light therapy were eligible for inclusion. Studies conducted outside the ICU, involving multiple CHAs, or enrolling pediatric patients were excluded. Data were extracted and assessed independently by two authors and reviewed by two additional authors. The Cochrane risk of bias tool was used to assess study quality.ResultsThirty-two RCTs were included involving 2,987 critically ill adults. CHAs evaluated included music (n = 19), nature based sounds (NBSs) (n = 4), aromatherapy (n = 3), light therapy (n = 2), massage (n = 2), and reflexology (n = 2). Half of all studies had a high risk of bias for randomization but had low or unclear biases for other categories. No study-related adverse events or safety-related concerns were reported. There were statistically significant improvements in pain (music, NBSs), anxiety (music, NBSs, aromatherapy, massage, reflexology), agitation (NBSs, reflexology), sleep (music, aromatherapy, reflexology), level of arousal (music, massage), and duration of mechanical ventilation (music, reflexology).ConclusionsEvidence suggests CHAs may reduce the symptom burden of critically ill adults.Copyright © 2019 Elsevier Ltd. All rights reserved.

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