NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia.
NHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia; School of Health Sciences, City University London, London, UK.
Int J Nurs Stud. 2015 Jul;52(7):1243-53. doi: 10.1016/j.ijnurstu.2015.03.020. Epub 2015 Apr 4.
To assess the effect of an intensive care unit (ICU) diary versus no ICU diary on patients, and their caregivers or families, during the patient's recovery from admission to an ICU.
Systematic review of randomized controlled trials (RCTs) and clinical controlled trials.
CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, PILOT; Web of Science Conference Proceedings, clinical trial registries and reference lists of identified trials.
Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria.
We identified three eligible studies; two describing ICU patients (N=358), and one describing relatives of ICU patients (N=30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07-1.19) or depression (RR 0.38, 95% CI 0.12-1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84-1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14-28), in comparison to no diary (median 28; range 14-38).
Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.
评估重症监护病房（ICU）日记与无 ICU 日记对患者及其护理人员或家属在 ICU 住院康复期间的影响。
对随机对照试验（RCT）和临床对照试验进行系统评价。
CENTRAL、MEDLINE、CINAHL、EMBASE、PsycINFO、PILOT；Web of Science 会议论文集、临床试验注册处和已确定试验的参考文献列表。
评估患者日记对患者或家庭成员在 ICU 住院康复期间的有效性，包括描述 ICU 后恢复的创伤后应激障碍（PTSD）、焦虑、抑郁和创伤后应激症状、健康相关生活质量和成本的风险。我们使用了符合 Cochrane 协作组预期的标准方法学方法。两名综述作者独立审查标题以确定是否纳入，提取数据并根据预先规定的标准进行偏倚风险评估。
我们确定了三项符合条件的研究；两项研究描述了 ICU 患者（N=358），一项研究描述了 ICU 患者的亲属（N=30）。没有研究充分报告使用临床访谈、家庭或护理人员焦虑或抑郁、健康相关生活质量或成本来描述 PTSD 风险。在一项单独的研究中，与未接受 ICU 日记的患者相比，接受 ICU 日记的患者在出现焦虑（RR 0.29，95%CI 0.07-1.19）或抑郁（RR 0.38，95%CI 0.12-1.19）的风险方面没有明显证据。在一项单独的研究中，接受 ICU 日记的 ICU 住院康复患者与未接受 ICU 日记的患者之间的创伤后应激症状评分中位数（日记 24，SD 11.6；无日记 24，SD 11.6）和 ICU 记忆幻觉回忆（RR 1.04，95%CI 0.84-1.28）没有差异。一项研究报告称，与未接受 ICU 日记的患者相比，接受 ICU 日记的 ICU 住院康复患者的家庭成员创伤后应激症状有所减轻（中位数 19；范围 14-28），而未接受 ICU 日记的患者（中位数 28；范围 14-38）。
目前，RCT 提供的关于患者及其护理人员或家属使用患者日记的益处或危害的证据很少。一项小型研究描述了它们在减轻家庭成员创伤后应激症状方面的潜力。然而，目前尚无足够证据支持其在改善患者及其家属的重症后心理康复方面的有效性。
