Clark Sigrún Eyrúnardóttir, Chisnall Georgia, Vindrola-Padros Cecilia
Rapid Research, Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, London W1W 7TY, UK.
EClinicalMedicine. 2022 Feb;44:101286. doi: 10.1016/j.eclinm.2022.101286. Epub 2022 Feb 7.
Intensive care units (ICUs) experienced a surge in patient cases during the COVID-19 pandemic. Demand was managed by redeploying healthcare workers (HCWs) and restructuring facilities. The rate of ICU admissions has subsided in many regions, with the redeployed workforce and facilities returning to usual functions. Previous literature has focused on the escalation of ICUs, limited research exists on de-escalation. This study aimed to identify the supportive and operational strategies used for the flexible de-escalation of ICUs in the context of COVID-19.
The systematic review was developed by searching eight databases in April and November 2021. Papers discussing the return of redeployed staff and facilities and the training, wellbeing, and operational strategies were included. Excluded papers were non-English and unrelated to ICU de-escalation. Quality was assessed using the mixed methods appraisal tool (MMAT) and authority, accuracy, coverage, objectivity, date, and significance (AACODS) checklist, findings were developed using narrative synthesis and thematic analysis.
Fifteen papers were included from six countries covering wellbeing and training themes encompassing; time off, psychological follow-up, gratitude, identification of training needs, missed training catch-up, and continuation of ICU and disaster management training. Operational themes included management of rotas, retainment of staff, division of ICU facilities, leadership changes, traffic light systems, and preparation for re-expansion.
The review provided an overview of the landscape of de-escalation strategies that have taken place in six countries. Limited empirical evidence was available that evaluated the effectiveness of such strategies. Empirical and evaluative research from a larger array of countries is needed to be able to make global recommendations on ICU de-escalation practices.
在新冠疫情期间，重症监护病房（ICU）的患者数量激增。通过重新调配医护人员（HCW）和重组设施来应对需求。许多地区的ICU入院率已经下降，重新调配的劳动力和设施恢复了正常功能。以往的文献主要关注ICU的升级，而关于降级的研究较少。本研究旨在确定在新冠疫情背景下用于ICU灵活降级的支持性和操作性策略。
2021年4月和11月通过检索八个数据库开展系统评价。纳入讨论重新调配的人员和设施回归以及培训、福祉和操作策略的论文。排除非英文且与ICU降级无关的论文。使用混合方法评估工具（MMAT）以及权威性、准确性、覆盖范围、客观性、日期和重要性（AACODS）清单评估质量，研究结果采用叙述性综合和主题分析得出。
纳入了来自六个国家的15篇论文，涵盖福祉和培训主题，包括；休假、心理随访、感恩、培训需求识别、错过培训的补习以及ICU和灾害管理培训的延续。操作主题包括排班管理、人员留用、ICU设施划分、领导变更、交通灯系统以及重新扩张准备。
该综述概述了六个国家实施的降级策略情况。评估此类策略有效性的实证证据有限。需要来自更多国家的实证和评估研究，以便能够就ICU降级实践提出全球建议。
