Intensive Care Unit, Hospital da Mulher, Bahia, Brazil.
Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil.
Crit Care Med. 2022 Nov 1;50(11):1654-1661. doi: 10.1097/CCM.0000000000005622. Epub 2022 Jul 21.
We aimed to identify which set of components differentiates the ICU diaries that were effective in reducing psychologic symptoms after critical illness.
We searched the online databases MEDLINE, OVID, Embase, and EBSCOhost from inception to December 2021.
Randomized controlled trials (RCTs) of the ICU diary were included, irrespective of the language, with samples of adult patients (≥ 18 yr old) and/or their relatives hospitalized in an ICU for more than 24 hours. Two qualitative syntheses on patients' and healthcare providers' perceptions on the ICU diary were included.
Four findings were extracted from the qualitative synthesis of patients' perspectives on the ICU diary. From the RCTs, we extracted the components of the ICU diary and whether the patients were ventilated for at least 3 days. We reported the outcome as effective or not, regardless of the psychiatric symptoms and diagnostic tools used for evaluation. We built a matrix in which each column represented a recommendation for an intervention component derived from the qualitative review, and each row represented whether the components of an individual trial's intervention matched any of the recommendations.
Eight RCTs were included in the final analysis. The sample of five studies consisted of patients under mechanical ventilation (MV) for at least 3 days. Two were positive trials. Three RCTs included family members, and two of those were positive trials.
For patients under MV for at least 3 days, the ICU diaries that were effective in preventing psychiatric symptoms after critical illness were written by the ICU staff, delivered after hospital discharge, and read with a healthcare professional in order to better understand the diary and the ICU stay. For family members, the presence of photographs was the only characteristic identified a successful ICU diary.
我们旨在确定哪一组组件能够区分出对重症后心理症状有减轻作用的 ICU 日记。
我们从 2021 年 12 月之前的在线数据库 MEDLINE、OVID、Embase 和 EBSCOhost 中进行了搜索。
纳入 ICU 日记的随机对照试验（RCT），不论语言如何，样本包括成年患者（≥18 岁）和/或在 ICU 住院超过 24 小时的患者及其亲属。还纳入了两项关于患者和医疗保健提供者对 ICU 日记看法的定性综合研究。
从 ICU 日记患者观点的定性综合研究中提取了四项发现。从 RCT 中，我们提取了 ICU 日记的组成部分以及患者是否至少接受了 3 天的机械通气。我们报告了结果是否有效，而不考虑用于评估的精神症状和诊断工具。我们构建了一个矩阵，其中每一列代表从定性综述中得出的干预措施的建议组成部分，每一行代表个别试验干预措施的组成部分是否符合任何建议。
最终分析纳入了 8 项 RCT。其中 5 项研究的样本包括至少接受 3 天机械通气的患者。有两项是阳性试验。有三项 RCT 纳入了家属，其中有两项是阳性试验。
对于至少接受 3 天机械通气的患者，对重症后预防精神症状有作用的 ICU 日记应由 ICU 工作人员书写，在出院后交付，并由医疗保健专业人员阅读，以更好地理解日记和 ICU 住院经历。对于家属来说，照片的存在是唯一能够确定成功的 ICU 日记的特征。
