Stewart Jonathan, Pauley Ellen, Wilson Danielle, Bradley Judy, Hart Nigel, McAuley Danny
Queen's University Belfast, Belfast, UK.
J Intensive Care Soc. 2025 Jan 3;26(1):80-95. doi: 10.1177/17511437241308674. eCollection 2025 Feb.
Survivors of intensive care unit (ICU) admission experience significant deficits in health-related quality of life due to long-term physical, psychological, and cognitive sequelae of critical illness, which may persist for many years. There has been a proliferation of post-hospital interventions in recent years which aim to support ICU-survivors, however there is currently limited evidence to inform optimal approach. We therefore aimed to synthesise factors which impacted the implementation of these interventions from the perspective of healthcare providers, patients, and their carers, and to compare different intervention designs.
We conducted a systematic review and synthesis of qualitative evidence using four databases (MEDLINE, EMBASE, CINAHL and Web of Science) which were searched from inception to May 2024. The extraction and synthesis of factors which impacted intervention implementation was informed by the domains of the Consolidated Framework for Implementation Research (CFIR) and Template for Intervention Description and Replication (TIDieR) checklist.
Thirty-seven studies were included, reporting on a range of interventions including follow-up clinics and rehabilitation programmes. We identified some overarching principles and specific intervention component and design factors which may support in the design of future strategies to improve outcomes for ICU survivors. For each intervention characteristic, various patient, staff, and setting factors were found to impact implementation. Considering how the intervention will rely on and integrate with existing outpatient and community resources is likely to be important.
This review provides a framework to future research examining the optimal approach to supporting ICU survivor recovery following hospital discharge.
重症监护病房（ICU）住院幸存者由于危重症的长期身体、心理和认知后遗症，在健康相关生活质量方面存在显著缺陷，这些后遗症可能会持续多年。近年来，旨在支持ICU幸存者的出院后干预措施大量涌现，但目前为最佳方法提供依据的证据有限。因此，我们旨在从医疗服务提供者、患者及其护理人员的角度综合影响这些干预措施实施的因素，并比较不同的干预设计。
我们使用四个数据库（MEDLINE、EMBASE、CINAHL和Web of Science）进行了定性证据的系统综述和综合分析，检索时间从数据库创建至2024年5月。影响干预措施实施的因素的提取和综合分析参考了实施研究综合框架（CFIR）的领域以及干预描述与复制模板（TIDieR）清单。
纳入了37项研究，报告了一系列干预措施，包括随访门诊和康复项目。我们确定了一些总体原则以及特定的干预组成部分和设计因素，这些因素可能有助于设计未来的策略，以改善ICU幸存者的预后。对于每种干预特征，发现各种患者、工作人员和环境因素会影响实施。考虑干预措施将如何依赖并整合现有门诊和社区资源可能很重要。
本综述为未来研究提供了一个框架，以探讨出院后支持ICU幸存者康复的最佳方法。
