All authors: Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Crit Care Med. 2021 Jul 1;49(7):1169-1181. doi: 10.1097/CCM.0000000000004943.
Although the current coronavirus disease 2019 pandemic demonstrates the urgent need for the integration of tele-ICUs, there is still a lack of uniform regulations regarding the level of authority. We conducted a systematic review and meta-analysis to evaluate the impact of the level of authority in tele-ICU care on patient outcomes.
We searched MEDLINE, EMBASE, CENTRAL, and Web of Science from inception until August 30, 2020.
We searched for randomized controlled trials and observational studies comparing standard care plus tele-ICU care with standard care alone in critically ill patients.
Two authors performed data extraction and risk of bias assessment. Mean differences and risk ratios were calculated using a random-effects model.
A total of 20 studies with 477,637 patients (ntele-ICU care = 292,319, ncontrol = 185,318) were included. Although "decision-making authority" as the level of authority was associated with a significant reduction in ICU mortality (pooled risk ratio, 0.82; 95% CI, 0.71-0.94; p = 0.006), we found no advantage of tele-ICU care in studies with "expert tele-consultation" as the level of authority. With regard to length of stay, "decision-making authority" resulted in an advantage of tele-ICU care (ICU length of stay: pooled mean difference, -0.78; 95% CI, -1.46 to -0.10; p = 0.14; hospital length of stay: pooled mean difference, -1.54; 95% CI, -3.13 to 0.05; p = 0.06), whereas "expert tele-consultation" resulted in an advantage of standard care (ICU length of stay: pooled mean difference, 0.31; 95% CI, 0.10-0.53; p = 0.005; hospital length of stay: pooled mean difference, 0.58; 95% CI, -0.04 to 1.21; p = 0.07).
In contrast to expert tele-consultations, decision-making authority during tele-ICU care reduces mortality and length of stay in the ICU. This work confirms the urgent need for evidence-based ICU telemedicine guidelines and reveals potential benefits of uniform regulations regarding the level of authority when providing tele-ICU care.
尽管当前的 2019 年冠状病毒病大流行表明迫切需要将远程 ICU 整合在一起，但在权限级别方面仍缺乏统一的规定。我们进行了系统评价和荟萃分析，以评估远程 ICU 护理中的权限级别对患者结局的影响。
我们检索了 MEDLINE、EMBASE、CENTRAL 和 Web of Science，检索时间为 2020 年 8 月 30 日。
我们检索了比较标准护理加远程 ICU 护理与单独标准护理的危重病患者的随机对照试验和观察性研究。
两名作者进行了数据提取和偏倚风险评估。使用随机效应模型计算均值差异和风险比。
共纳入 20 项研究，涉及 477637 例患者（ntele-ICU care = 292319，ncontrol = 185318）。尽管“决策权限”作为权限级别与 ICU 死亡率显著降低相关（汇总风险比，0.82；95%CI，0.71-0.94；p = 0.006），但我们发现专家远程咨询作为权限级别，远程 ICU 护理没有优势。关于住院时间，“决策权限”使远程 ICU 护理具有优势（ICU 住院时间：汇总平均差异，-0.78；95%CI，-1.46 至-0.10；p = 0.14；住院时间：汇总平均差异，-1.54；95%CI，-3.13 至 0.05；p = 0.06），而“专家远程咨询”使标准护理具有优势（ICU 住院时间：汇总平均差异，0.31；95%CI，0.10-0.53；p = 0.005；住院时间：汇总平均差异，0.58；95%CI，-0.04 至 1.21；p = 0.07）。
与专家远程咨询相比，远程 ICU 护理中的决策权限可降低死亡率和 ICU 住院时间。这项工作证实了急需制定基于证据的 ICU 远程医疗指南，并揭示了在提供远程 ICU 护理时统一权限级别规定的潜在好处。
