Trauma Research Centre, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Anaesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran.
Anaesth Crit Care Pain Med. 2021 Dec;40(6):100950. doi: 10.1016/j.accpm.2021.100950. Epub 2021 Sep 20.
The difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question.
We conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs.
Medline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes.
A total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07-1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03-1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01-0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77-1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31-3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05).
The results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.
重症监护病房（ICU）的封闭设计和开放设计之间的临床结果差异仍然是一个悬而未决的问题。
我们进行了系统回顾和荟萃分析，以比较总死亡率、住院和 ICU 住院时间（LOS）以及死亡率作为主要结果，以及基于生理变量、器官衰竭评估、年龄、机械通气持续时间和呼吸机相关性肺炎频率的严重程度作为次要结果，比较封闭和开放 ICU 之间的差异。
根据 MeSH 术语，从 1988 年至 2019 年 10 月，使用 Medline、PubMed、Scopus、Web of Science、Cochrane 数据库、伊朗文档和 Elm-net 进行了搜索。应用标准化均数差（SMD）、相对风险（RR）和 95%置信区间（CI）来显示主要和次要结果的汇总统计数据。
共分析了 90 项研究，涉及 444,042 名参与者。开放 ICU 的 ICU 死亡率（RR：1.16，CI：1.07-1.27，p<0.001）、医院死亡率（RR：1.12，CI：1.03-1.22，p=0.010）和 ICU LOS（SMD：0.43，CI：0.01-0.85，p=0.040）显著更高。两种 ICU 类型之间总死亡率（RR：0.91，CI：0.77-1.08，p=0.28）和医院 LOS（SMD：1.14，CI：1.31-3.59，p=0.36）无显著差异。两种 ICU 类型之间的次要结局指标也无差异（p>0.05）。
结果表明，与开放 ICU 相比，封闭 ICU 在医院和 ICU 死亡率和 ICU LOS 方面具有优势，而总死亡率、医院 LOS 或严重程度参数无差异。封闭 ICU 模式的优势可能是由 intensivist 主导的患者护理所致，因此临床医生应实施该模式，以降低危重症患者的 ICU 死亡率和 LOS。
