Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Portland, USA.
Intensive Care Med. 2019 Aug;45(8):1072-1081. doi: 10.1007/s00134-019-05681-3. Epub 2019 Jul 3.
This study aimed to elucidate the impact of protocolized family support intervention on length of stay (LOS) in the intensive care unit (ICU) through a systematic review and meta-analysis.
Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and other web-based databases were referenced since inception until November 26, 2018. We included randomized-controlled trials wherein protocolized family support interventions were conducted for enhanced communication and shared medical decision-making. LOS (in days) and mortality were evaluated using a random-effects model, and adjusted LOS was estimated using a mixed-effects model.
We included seven randomized-controlled trials with 3477 patients. Protocolized family support interventions were found to significantly reduce the ICU LOS {mean difference = - 0.89 [95% confidence interval (CI) = - 1.50 to - 0.27]} and hospital LOS [mean difference = - 3.78 (95% CI = - 5.26 to - 2.29)]; the results of the mixed-effect model showed that they significantly reduced ICU LOS after adjusting for the therapeutic goal [mean difference = - 1.30 (95% CI = - 2.35 to - 0.26)], methods of measurement [mean difference = - 0.89 (95% CI = - 1.55 to - 0.22)], and timing of intervention [mean difference = - 1.05 (95% CI = - 2.05 to - 0.05)]. Similar results were found after adjusting for patients' disease severity [mean difference = - 1.21 (95% CI = - 2.03 to - 0.39)] and the trim-and-fill method [mean difference = - 0.86 (95% CI = - 1.44 to - 0.28)]. There was no difference in mortality rate in ICU and hospital between the protocolized intervention and control groups.
Protocolized family support intervention for enhanced communication and shared decision-making with the family reduced ICU LOS in critically ill patients without impacting mortality.
本研究旨在通过系统评价和荟萃分析阐明通过协议化家庭支持干预对重症监护病房（ICU）住院时间（LOS）的影响。
从成立到 2018 年 11 月 26 日，参考了 Medline、EMBASE、Cochrane 对照试验中心注册库和其他基于网络的数据库。我们纳入了进行强化沟通和共同医疗决策的协议化家庭支持干预的随机对照试验。使用随机效应模型评估 LOS（天数）和死亡率，并使用混合效应模型估计调整后的 LOS。
我们纳入了 7 项包含 3477 名患者的随机对照试验。协议化家庭支持干预可显著缩短 ICU LOS[平均差异=-0.89（95%置信区间（CI）=-1.50 至-0.27）]和住院 LOS[平均差异=-3.78（95%CI=-5.26 至-2.29)]；混合效应模型的结果表明，在调整治疗目标[平均差异=-1.30（95%CI=-2.35 至-0.26）]、测量方法[平均差异=-0.89（95%CI=-1.55 至-0.22）]和干预时间[平均差异=-1.05（95%CI=-2.05 至-0.05）]后，它们可显著缩短 ICU LOS。在调整患者疾病严重程度[平均差异=-1.21（95%CI=-2.03 至-0.39）]和修剪填充法[平均差异=-0.86（95%CI=-1.44 至-0.28）]后也得到了相似的结果。协议化干预组和对照组在 ICU 和医院的死亡率无差异。
针对强化沟通和家庭共同决策的协议化家庭支持干预可降低重症患者的 ICU LOS，而不影响死亡率。
