Department of Anesthesiology, Nordsjællands Hospital, University of Copenhagen, 3400, Hilleroed, Denmark,
Intensive Care Med. 2015 May;41(5):763-75. doi: 10.1007/s00134-015-3689-1. Epub 2015 Mar 3.
To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors.
Systematic literature review from five databases (Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL), reference lists, citation tracking, and ongoing/unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed quality independently. The mean differences, risk ratios, and 95 % confidence intervals were calculated depending on outcome measures.
From 1544 citations, five trials were included (855 patients). The overall risk of bias was low in two trials, unclear in two trials, and high in one trial. The overall quality of evidence was low. The trials assessed follow-up interventions defined as consultations informing survivors about their ICU stay. One trial found no effect on QOL. Pooling data from two trials (n = 374) showed a protective effect on risk of new onset PTSD at 3-6 months after ICU (risk ratio 0.49, 95 % CI 0.26-0.95). There was no effect on other outcomes.
The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.
评估常规随访咨询与重症监护病房（ICU）幸存者标准护理相比的影响。
对五个数据库（Cochrane 中心、MEDLINE、EMBASE、PsycINFO、CINAHL）、参考文献列表、引文追踪和正在进行/未发表的试验进行系统文献回顾。纳入了调查 ICU 后咨询对生活质量（QOL）、焦虑、抑郁、创伤后应激障碍（PTSD）、身体能力、认知功能和重返工作等结局的成人 ICU 幸存者的随机对照试验。两名审查员独立提取数据并评估质量。根据结局测量指标，计算平均差异、风险比和 95%置信区间。
从 1544 条引用中，纳入了五项试验（855 名患者）。两项试验的总体偏倚风险较低，两项试验的偏倚风险不明确，一项试验的偏倚风险较高。总体证据质量较低。这些试验评估了定义为告知幸存者其 ICU 入住情况的随访干预措施。一项试验未发现对 QOL 的影响。两项试验（n = 374）的数据汇总显示，在 ICU 出院后 3-6 个月时对新发 PTSD 的风险具有保护作用（风险比 0.49，95%置信区间 0.26-0.95）。对其他结局没有影响。
证据表明，随访咨询可能会降低 ICU 幸存者在 ICU 出院后 3-6 个月时 PTSD 的症状，但不会影响 QOL 和其他调查结局。本综述强调，未来 RCT 的规划应旨在标准化干预措施和结局测量，以允许在研究之间进行比较。
