The Department of Psychiatry, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ.
The Department of Emergency Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ.
Crit Care Med. 2018 Aug;46(8):1328-1333. doi: 10.1097/CCM.0000000000003222.
Posttraumatic stress disorder among survivors of critical illness is of public health importance, as it is common and reduces patient quality of life. The objective of this systematic review was to collate the world's literature on interventions aimed at preventing posttraumatic stress disorder among survivors of critical illness.
We performed a search of CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trials registry platforms, with no restriction to language using a comprehensive strategy.
Study inclusion criteria were as follows: 1) adult human subjects, 2) patients treated in an ICU setting, 3) intervention arm aimed at reducing posttraumatic stress disorder symptoms, 4) use of a control arm, and 5) an outcome measure assessing development of acute stress or posttraumatic stress disorder symptoms.
We performed a qualitative analysis to collate and summarize effects of identified interventions according to the recommended methodology from the Cochrane Handbook.
Seventeen studies met all inclusion and no exclusion criteria. There was heterogeneity in interventions and outcome measures used. All studies had some concern for risk of bias as per the Cochrane tool for assessing risk of bias. In eight of 12 studies (67%) testing early interventions (i.e., initiated in the ICU course) and one of five studies (20%) testing delayed interventions following ICU discharge, posttraumatic stress disorder symptoms were decreased among the intervention group compared with controls.
Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective.
危重病幸存者的创伤后应激障碍具有重要的公共卫生意义，因为它很常见，会降低患者的生活质量。本系统评价的目的是整理全球关于预防危重病幸存者创伤后应激障碍的干预措施的文献。
我们使用全面的策略，在 CENTRAL、MEDLINE、EMBASE、CINAHL 和临床试验登记平台上对文献进行了无语言限制的检索。
研究纳入标准如下：1）成人受试者，2）在 ICU 接受治疗的患者，3）干预组旨在减少创伤后应激障碍症状，4）使用对照组，5）使用评估急性应激或创伤后应激障碍症状发展的结局测量。
我们根据 Cochrane 手册推荐的方法进行了定性分析，以整理和总结已确定干预措施的效果。
17 项研究均符合所有纳入标准，无排除标准。干预措施和使用的结局测量存在异质性。根据 Cochrane 评估偏倚风险工具，所有研究均存在一定的偏倚风险。在 12 项早期干预研究中的 8 项（67%）和 5 项 ICU 出院后延迟干预研究中的 1 项（20%）中，与对照组相比，干预组的创伤后应激障碍症状有所降低。
尽管高质量的临床研究较少，但迄今为止的大多数证据表明，1）危重病幸存者的创伤后应激障碍可能是可预防的，2）早期干预可能是最有效的。
