Fang Dihui, Zeng Lilan, Kuang Fang
The Intensive Care Unit of the East Hospital of Chenzhou First People's Hospital in Chenzhou City, Chenzhou, Hunan, 423000, China.
District 3, Critical Care Medicine Department, Central Hospital of Chenzhou First People's Hospital in Chenzhou City, Chenzhou, Hunan, 423000, China.
BMC Nurs. 2025 Apr 1;24(1):356. doi: 10.1186/s12912-025-03013-z.
The aim is to explore the impact of care bundles on the efficacy and safety of delirium management in intensive care unit (ICU) patients compared to standard care through a meta-analysis and systematic review.
China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Web of Science (WOS), Embase, Cochrane, Chinese Biomedical Database (CBM), and VIP databases were searched from the database inception to December 1, 2024. The inclusion criteria based on the PICOS strategy include ICU patients (P), and randomized controlled trials (RCT) (S) comparing the treatment outcomes (such as incidence of delirium, duration of delirium, duration of mechanical ventilation, mortality rate, etc.) (O) between the care bundles (I) and standard care (C). Two investigators independently screened the literature, extracted the data, and assessed the quality of the included literature using the Cochrane Quality Assessment Tool. Meta-analysis was performed using STATA15.0 software.
Eighteen studies were included with a total of 2,717patients involved. Most studies have a high/moderate risk of bias. The results of the meta-analysis demonstrated that care bundles was effective in decreasing the (1)incidence of delirium in ICU patients [risk ratio [RR] = 0.38, 95% confidence interval [CI] : 0.32, 0.45; P < 0.001], shortening the (2)duration of delirium(days) (weighted mean difference [WMD] = -1.60, 95% CI : -1.96, -1.23; P < 0.001), and (3)duration of mechanical ventilation in corresponding patients(days) (standardized mean difference [SMD] = -1.65, 95% CI : -2.40, -0.89; P < 0.001). However, there was no statistical difference in patient (4) mortality (RR = 0.78, 95% CI : 0.44, 1.40; P = 0.41).
Care bundles have positive effects on delirium in ICU patients. However, results with significant heterogeneity should be interpreted with caution, and differences in bundles need to be taken into account. More multi-center, largesample randomized controlled studies are required to further explore the optimal components and combinations of care bundles.
通过荟萃分析和系统评价，探讨与标准护理相比，护理集束对重症监护病房（ICU）患者谵妄管理的疗效和安全性的影响。
检索中国知网（CNKI）、万方、PubMed、Web of Science（WOS）、Embase、Cochrane、中国生物医学数据库（CBM）和维普数据库，检索时间从建库至2024年12月1日。基于PICOS策略的纳入标准包括ICU患者（P），以及比较护理集束（I）和标准护理（C）之间治疗结果（如谵妄发生率、谵妄持续时间、机械通气持续时间、死亡率等）（O）的随机对照试验（RCT）（S）。两名研究者独立筛选文献、提取数据，并使用Cochrane质量评估工具评估纳入文献的质量。使用STATA15.0软件进行荟萃分析。
纳入18项研究，共涉及2717例患者。大多数研究存在高/中度偏倚风险。荟萃分析结果表明，护理集束在降低（1）ICU患者谵妄发生率方面有效[风险比（RR）=0.38，95%置信区间（CI）：0.32，0.45；P<0.001]，缩短（2）谵妄持续时间（天）（加权均数差（WMD）=-1.60，95%CI：-1.96，-1.23；P<0.001），以及缩短（3）相应患者的机械通气持续时间（天）（标准化均数差（SMD）=-1.65，95%CI：-2.40，-0.89；P<0.001）。然而，患者（4）死亡率方面无统计学差异（RR=0.78，95%CI：0.44，1.40；P=0.41）。
护理集束对ICU患者的谵妄有积极作用。然而，对于具有显著异质性的结果应谨慎解读，并需考虑护理集束的差异。需要更多多中心、大样本随机对照研究来进一步探索护理集束的最佳组成部分和组合。
