目的:护理捆绑被认为是提高重症监护病房(ICU)床边护理质量的关键工具。我们探讨了它们对长期患者相关结局的影响。
方法:系统的文献检索和范围审查。
方法:我们搜索了PubMed,Embase,CINAHL,APAPsycInfo,WebofScience,重症监护关键字的CDSR和CENTRAL,护理捆绑包,患者相关结果,和后续研究。
方法:成人ICU收治的患者的原始文章评估捆绑实施并测量长期(即,ICU出院或以后)患者相关结果(即,死亡率,健康相关生活质量(HrQoL),重症监护后综合征(PICS),与护理相关的结果,不良事件,和社会健康)。
方法:经过双重处理,独立,两阶段选择和制图,合格的记录经过严格评估和评估,实施战略,以及对长期患者相关结局的影响。
结果:在2012年的记录中,38人符合纳入标准;55%(n=21)是研究前后,21%(n=8)观察性队列研究,13%(n=5)随机对照试验,11%(n=4)有其他设计。与脓毒症有关的束(n=11),神经认知(n=6),通信(n=4),早期康复(n=3),药物停药(n=3),通气(n=2)或组合束(n=9)。几乎三分之二的研究报告生存(n=24),45%(n=17)与护理相关的结果(例如,放电处理),13%(n=5)的HrQoL研究。关于PICS,24%(n=9)评估认知,13%(n=5)身体健康,和11%(n=4)的心理健康,出院后1年。捆绑对长期患者相关结局的影响尚无定论,除了败血症束对生存的积极影响。不确定的影响可能是由于纳入研究的高风险偏倚和实施策略的可变性,仪器,和后续时间。
结论:有必要探索ICU捆绑对HrQoL和PICS的长期影响。缩小这一知识差距对于确定ICU捆绑包是否具有长期患者价值至关重要。
Care bundles are considered a key tool to improve bedside quality of care in the intensive care unit (ICU). We explored their effect on long-term patient-relevant outcomes.
Systematic literature search and scoping
review.
We searched PubMed, Embase, CINAHL, APA PsycInfo, Web of Science, CDSR and CENTRAL for keywords of intensive care, care bundles, patient-relevant outcomes, and follow-up studies.
Original articles with patients admitted to adult ICUs assessing bundle implementations and measuring long-term (ie, ICU discharge or later) patient-relevant outcomes (ie, mortality, health-related quality of life (HrQoL), post-intensive care syndrome (PICS), care-related outcomes, adverse events, and social health).
After dual, independent, two-stage selection and charting, eligible records were critically appraised and assessed for bundle type, implementation strategies, and effects on long-term patient-relevant outcomes.
Of 2012 records, 38 met inclusion criteria; 55% (n=21) were before-after studies, 21% (n=8) observational cohort studies, 13% (n=5) randomised controlled trials, and 11% (n=4) had other designs. Bundles pertained to sepsis (n=11), neurocognition (n=6), communication (n=4), early rehabilitation (n=3), pharmacological discontinuation (n=3), ventilation (n=2) or combined bundles (n=9). Almost two-thirds of the studies reported on survival (n=24), 45% (n=17) on care-related outcomes (eg, discharge disposition), and 13% (n=5) of studies on HrQoL. Regarding PICS, 24% (n=9) assessed cognition, 13% (n=5) physical health, and 11% (n=4) mental health, up to 1 year after discharge. The effects of bundles on long-term patient-relevant outcomes was inconclusive, except for a positive effect of sepsis bundles on survival. The inconclusive effects may have been due to the high risk of bias in included studies and the variability in implementation strategies, instruments, and follow-up times.
There is a need to explore the long-term effects of ICU bundles on HrQoL and PICS. Closing this knowledge gap appears vital to determine if there is long-term patient value of ICU bundles.