Nydahl P, Fischill M, Deffner T, Neudeck V, Heindl P
Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
Med Klin Intensivmed Notfmed. 2019 Feb;114(1):68-76. doi: 10.1007/s00063-018-0456-4. Epub 2018 Jul 11.
Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications.
The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment.
The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%.
ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
临床医生和亲属为重症监护病房（ICU）的患者撰写日记，以降低创伤后应激障碍（PTSD）、焦虑和抑郁等心理并发症的风险。2015年发表的一篇关于该主题的Cochrane系统评价的作者纳入了基于合格人员访谈进行PTSD诊断的研究，并得出结论，没有足够的证据支持ICU日记能降低心理并发症风险这一论点。
本研究采用与Cochrane系统评价相同的检索算法复制其设计，但纳入了原始Cochrane系统评价未考虑的经验证的心理并发症诊断方法的额外结局数据。主要结局是有ICU日记的患者或亲属中的PTSD。次要结局是焦虑和/或抑郁症状。使用Cochrane偏倚风险评估来评估研究质量。
重复检索产生了3179条引文，其中有6项符合条件的研究，605名患者和145名亲属可纳入荟萃分析。研究评级从低到高。PTSD结局的荟萃分析表明：（a）对于ICU患者（4项研究，n = 569名患者），降低不显著（比值比[OR] 0.58，95%置信区间[CI]：0.24 - 1.42，p = 0.23），以及（b）对于亲属的PTSD（2项研究，n = 145名亲属），降低显著（OR 0.17，95%CI：0.08 - 0.38，p < 0.0001）。ICU患者的焦虑和抑郁症状（每项2项研究，n = 88名患者）显著降低（OR分别为0.23，95%CI：0.07 - 0.77，p = 0.02；OR 0.27，95%CI：0.09 - 0.77，p = 0.01）。异质性在0%至54%之间。
ICU日记可能会降低患者及其亲属在ICU住院后发生心理并发症的风险。
