Intensive Care Unit, The Royal Melbourne Hospital, Victoria, Australia.
Department of Physiotherapy, Western Health, Victoria, Australia; Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia.
Aust Crit Care. 2024 May;37(3):508-516. doi: 10.1016/j.aucc.2023.04.005. Epub 2023 May 31.
BACKGROUND: The optimal model of outpatient intensive care unit (ICU) follow-up care remains uncertain, and there is limited evidence of benefit. RESEARCH QUESTION: The objective of this research is to describe existing models of outpatient ICU follow-up care, quantify participant recruitment and retention, and describe facilitators of patient engagement. STUDY DESIGN & METHODS: A systematic search of the MEDLINE and EMBASE databases was undertaken in June 2021. Two independent reviewers screened titles, abstracts, and full texts against eligibility criteria. Studies of adults with any outpatient ICU follow-up were included. Studies were excluded if published before 1990, not published in English, or of paediatric patients. Quantitative data were extracted using predefined data fields. Key themes were extracted from qualitative studies. Risk of bias was assessed. RESULTS: A total of 531 studies were screened. Forty-seven studies (32 quantitative and 15 qualitative studies) with a total of 5998 participants were included. Of 33 quantitative study interventions, the most frequently reported model of care was in-person hospital-based interventions (n = 27), with 10 hybrid (part in-hospital, part remote) interventions. Literature was limited for interventions without hospital attendance (n = 6), including telehealth and diaries. The median ranges of rates of recruitment, rates of intervention delivery, and retention to outcome assessment for hospital-based interventions were 51.5% [24-94%], 61.9% [8-100%], and 52% [8.1-82%], respectively. Rates were higher for interventions without hospital attendance: 82.6% [60-100%], 68.5% [59-89%], and 75% [54-100%]. Facilitators of engagement included patient-perceived value of follow-up, continuity of care, intervention accessibility and flexibility, and follow-up design. Studies had a moderate risk of bias. INTERPRETATION: Models of post-ICU care without in-person attendance at the index hospital potentially have higher rates of recruitment, intervention delivery success, and increased participant retention when compared to hospital-based interventions. PROSPERO REGISTRATION: CRD42021260279.
背景：门诊重症监护病房（ICU）随访护理的最佳模式仍不确定，并且获益的证据有限。
研究问题：本研究旨在描述现有的门诊 ICU 随访护理模式，量化参与者的招募和保留情况，并描述促进患者参与的因素。
研究设计和方法：2021 年 6 月，对 MEDLINE 和 EMBASE 数据库进行了系统检索。两名独立的审查员根据入选标准筛选标题、摘要和全文。纳入了所有接受门诊 ICU 随访的成人患者的研究。如果研究发表于 1990 年以前、非英文发表或为儿科患者，则将其排除。使用预定义的数据字段提取定量数据。从定性研究中提取关键主题。评估偏倚风险。
结果：共筛选出 531 项研究。47 项研究（32 项定量研究和 15 项定性研究）共纳入 5998 名参与者。在 33 项定量研究干预措施中，最常报道的护理模式是基于医院的面对面干预（n=27），其中 10 项为混合（部分院内，部分远程）干预。无医院就诊干预措施的文献有限（n=6），包括远程医疗和日记。基于医院的干预措施的招募率、干预实施率和保留到结局评估的中位数范围分别为 51.5%（24-94%）、61.9%（8-100%）和 52%（8.1-82%）。无医院就诊的干预措施的招募率更高：82.6%（60-100%）、68.5%（59-89%）和 75%（54-100%）。参与的促进因素包括患者对随访的感知价值、连续性护理、干预的可及性和灵活性以及随访设计。研究的偏倚风险为中度。
解释：与基于医院的干预措施相比，无医院就诊的 ICU 后护理模式可能具有更高的招募率、干预实施成功率和参与者保留率。
PROSPERO 注册号：CRD42021260279。
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