1 Centre for Telemedicine, Shanghai Fifth People's Hospital, Fudan University, Minhang District, Shanghai, China.
2 Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Minhang District, Shanghai, China.
J Intensive Care Med. 2018 Jul;33(7):383-393. doi: 10.1177/0885066617726942. Epub 2017 Aug 22.
To evaluate the impact of telemedicine programs in intensive care unit (Tele-ICU) on ICU or hospital mortality or ICU or hospital length of stay and to summarize available data on implementation cost of Tele-ICU.
Controlled trails or observational studies assessing outcomes of interest were identified by searching 7 electronic databases from inception to July 2016 and related journals and conference literatures between 2000 and 2016. Two reviewers independently screened searched records, extracted data, and assessed the quality of included studies. Random-effect models were applied to meta-analyses and sensitivity analysis.
Nineteen of 1035 records fulfilled the inclusion criteria. The pooled effects demonstrated that Tele-ICU programs were associated with reductions in ICU mortality (15 studies; risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.96; P = .01), hospital mortality (13 studies; RR, 0.74; 95% CIs, 0.58 to 0.96; P = .02), and ICU length of stay (9 studies; mean difference [MD], -0.63; 95% CI, -0.28 to 0.17; P = .007). However, there is no significant association between the reduction in hospital length of stay and Tele-ICU programs. Summary data concerning costs suggested approximately US$50 000 to US$100 000 per Tele-ICU bed was required to implement Tele-ICU programs for the first year. Hospital costs of US$2600 reduction to US$5600 increase per patient were estimated using Tele-ICU programs.
This systematic review and meta-analysis provided limited evidence that Tele-ICU approaches may reduce the ICU and hospital mortality, shorten the ICU length of stay, but have no significant effect in hospital length of stay. Implementation of Tele-ICU programs substantially costs and its long-term cost-effectiveness is still unclear.
评估重症监护病房（Tele-ICU）中的远程医疗计划对 ICU 或医院死亡率或 ICU 或医院住院时间的影响，并总结 Tele-ICU 实施成本的现有数据。
通过搜索 7 个电子数据库，从成立到 2016 年 7 月，以及 2000 年至 2016 年的相关期刊和会议文献，确定了评估相关结果的对照试验或观察性研究。两位审查员独立筛选检索记录、提取数据并评估纳入研究的质量。应用随机效应模型进行荟萃分析和敏感性分析。
从 1035 条记录中筛选出 19 项符合纳入标准的研究。汇总结果表明，Tele-ICU 方案与降低 ICU 死亡率（15 项研究；风险比 [RR]，0.83；95%置信区间 [CI]，0.72 至 0.96；P =.01）、医院死亡率（13 项研究；RR，0.74；95%CI，0.58 至 0.96；P =.02）和 ICU 住院时间（9 项研究；平均差 [MD]，-0.63；95%CI，-0.28 至 0.17；P =.007）有关。然而，Tele-ICU 方案与降低医院住院时间之间没有显著关联。有关成本的综合数据表明，实施 Tele-ICU 方案的第一年，每个 Tele-ICU 床位需要约 5 万至 10 万美元。使用 Tele-ICU 方案，估计每位患者的医院成本可降低 2600 美元至增加 5600 美元。
本系统评价和荟萃分析提供了有限的证据，表明 Tele-ICU 方法可能降低 ICU 和医院死亡率，缩短 ICU 住院时间，但对医院住院时间没有显著影响。Tele-ICU 方案的实施成本很高，其长期成本效益尚不清楚。
