Barbateskovic Marija, Larsen Laura Krone, Oxenbøll-Collet Marie, Jakobsen Janus Christian, Perner Anders, Wetterslev Jørn
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Centre for Research in Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Syst Rev. 2016 Dec 7;5(1):211. doi: 10.1186/s13643-016-0391-5.
The prevalence of delirium in intensive care unit (ICU) patients is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer ICU stay, increased long-term mortality and cognitive impairment. Thus, the burden of delirium for patients, relatives and societies is considerable. Today, reviews of randomised clinical trials are produced in large scales sometimes making it difficult to get an overview of the available evidence. A preliminary search identified several reviews investigating the effects of pharmacological interventions for the management and prevention of delirium in ICU patients. The conclusions of the reviews showed conflicting results. Despite this unclear evidence, antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients. The objective of this overview of reviews is to critically assess the evidence of reviews of randomised clinical trials on the effect of pharmacological management and prevention of delirium in ICU patients.
METHODS/DESIGN: We will search for reviews in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, and Allied and Complementary Medicine Database. Two authors will independently select references for inclusion using Covidence, extract data and assess the methodological quality of the included systematic reviews using the ROBIS tool. Any disagreement will be resolved by consensus. We will present the data as a narrative synthesis and summarise the main results of the included reviews. In addition, we will present an overview of the bias risk assessment of the systematic reviews.
Results of this overview may establish a way forward to find and update or to design a high quality systematic review assessing the effects of the most promising pharmacological intervention for delirium in ICU patients.
PROSPERO - CRD42016046628 .
重症监护病房（ICU）患者中谵妄的患病率很高。谵妄与发病率和死亡率相关，包括更多的机械通气天数、更长的ICU住院时间、更高的长期死亡率和认知障碍。因此，谵妄给患者、亲属和社会带来的负担相当大。如今，随机临床试验的综述大量涌现，有时让人难以全面了解现有证据。初步检索发现了几篇综述，研究了药物干预对ICU患者谵妄的管理和预防效果。这些综述的结论显示结果相互矛盾。尽管证据不明确，但抗精神病药物，尤其是氟哌啶醇，通常是ICU患者谵妄推荐的药物干预措施。本综述的目的是严格评估关于ICU患者谵妄药物管理和预防效果的随机临床试验综述的证据。
方法/设计：我们将在以下数据库中检索综述：考克兰图书馆、医学索引数据库、荷兰医学文摘数据库、科学引文索引、生物学文摘数据库、护理学与健康相关文献累积索引、拉丁美洲和加勒比健康科学文献数据库以及补充和替代医学数据库。两位作者将使用Covidence独立选择纳入的参考文献，提取数据，并使用ROBIS工具评估纳入的系统评价的方法学质量。任何分歧将通过协商解决。我们将以叙述性综述的形式呈现数据，并总结纳入综述的主要结果。此外，我们将概述系统评价的偏倚风险评估。
本综述的结果可能为寻找和更新或设计高质量系统评价提供一条途径，以评估最有前景的药物干预对ICU患者谵妄的影响。
国际前瞻性系统评价注册库 - CRD42016046628 。
