Qin Mubing, Gao Yanxia, Guo Shigong, Lu Xin, Zhu Huadong, Li Yi
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Emergency Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
J Clin Neurosci. 2022 Feb;96:114-119. doi: 10.1016/j.jocn.2021.11.011. Epub 2021 Nov 24.
Delirium is one of the common manifestations of acute brain dysfunction in critically ill patients. We aimed to evaluate the effect of family intervention on reducing the delirium incidence in patients hospitalized in the intensive care unit (ICU). We searched electronic databases for randomized clinical trials, cohort, and before-and-after studies up to September 2021 using the MeSH terms ("family" OR "family caregiver") AND ("delirium"). A total of 6 studies including 4199 patients were analyzed. Compared to the control group, the risk of delirium was 24% lower in the family intervention group (OR 0·76 [0·67-0·86], P = 0.20, I = 31%). Pooled data from two trials showed that family intervention was associated with fewer delirium days (SMD: -1.13, 95% CI: -1.91 to -0.34; P = 0.08; I = 67%;). However, there were no significant differences between the two groups in the length of ICU stay, mechanical ventilation duration, and mortality (ICU stay days: MD: -0.62 days; 95% CI: -1.49 to 0.24; P = 0.14; I = 72%; mechanical ventilation days: MD: -0.48 days; 95% CI: -2.10 to 1.13; P = 0.56; I = 0%; mortality: OR: 0.68, 95% CI: 0.22 to 2.09; P = 0.08; I = 67%). Current evidence supports the use of family intervention in reducing the delirium risk and delirium days in hospitalized ICU patients. However, its effects on reducing ICU stay length, ventilation duration, and mortality require further study. Future research should consider identifying the specific family intervention strategies and their duration.
谵妄是危重症患者急性脑功能障碍的常见表现之一。我们旨在评估家庭干预对降低重症监护病房（ICU）住院患者谵妄发生率的效果。我们使用医学主题词（“家庭”或“家庭照顾者”）和（“谵妄”）在电子数据库中检索截至2021年9月的随机临床试验、队列研究和前后对照研究。共分析了6项研究，包括4199名患者。与对照组相比，家庭干预组谵妄风险降低24%（OR 0·76 [0·67 - 0·86]，P = 0.20，I = 31%）。两项试验的汇总数据显示，家庭干预与谵妄天数减少相关（标准化均数差：-1.13，95%可信区间：-1.91至-0.34；P = 0.08；I = 67%）。然而，两组在ICU住院时间、机械通气时间和死亡率方面无显著差异（ICU住院天数：MD：-0.62天；95%可信区间：-1.49至0.24；P = 0.14；I = 72%；机械通气天数：MD：-0.48天；95%可信区间：-2.10至1.13；P = 0.56；I = 0%；死亡率：OR：0.68，95%可信区间：0.22至2.09；P = 0.08；I = 67%）。现有证据支持在降低住院ICU患者谵妄风险和谵妄天数方面使用家庭干预。然而，其对缩短ICU住院时间、通气时间和降低死亡率的影响需要进一步研究。未来研究应考虑确定具体的家庭干预策略及其持续时间。
