Effect of ICU care bundles on long-term patient-relevant outcomes: a scoping review.

Autor:	Paul N; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Ribet Buse E; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Knauthe AC; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Nothacker M; Institute for Medical Knowledge Management, Association of the Scientific Medical Societies in Germany (AWMF), Philipps-Universität Marburg, Marburg, Germany., Weiss B; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Spies CD; Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany claudia.spies@charite.de.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Feb 17; Vol. 13 (2), pp. e070962. Date of Electronic Publication: 2023 Feb 17.
DOI:	10.1136/bmjopen-2022-070962
Abstrakt:	Objective: 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. Design: Systematic literature search and scoping review. Data Sources: 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. Eligibility Criteria: 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). Data Extraction and Synthesis: 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. Results: 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. Conclusions: 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. Competing Interests: Competing interests: NP, A-CK, ERB and MN have no conflicts of interest to declare. BW reports grants from Gemeinsamer Bundesausschuss/Federal Joint Committee (G-BA) – Innovationsfonds and the European Society of Intensive Care Medicine (ESICM), outside the submitted work, and consulting fees from OrionPharma, honoraria from Dr F. Köhler Chemie, support for attending meetings and travel from Teladoc Health, a leadership role as ESICM NEXT Chair, a member role in the ESICM ARDS Guideline Group and a member role in the COVRIIN Group of the Robert Koch Institute. CDS reports grants from Deutsche Forschungsgemeinschaft/German Research Society, during the conduct of the study; grants from Drägerwerk AG & Co. KGaA, grants from Deutsche Forschungsgemeinschaft/German Research Society, grants from Deutsches Zentrum für Luft- und Raumfahrt (DLR)/German Aerospace Center, grants from Einstein Stiftung Berlin/Einstein Foundation Berlin, grants from Gemeinsamer Bundesausschuss/Federal Joint Committee (G-BA), grants from Inneruniversitäre Forschungsförderung/Inner University Grants, grants from Projektträger im DLR/Project Management Agency, grants from Stifterverband/Non-Profit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from Baxter Deutschland GmbH, grants from Cytosorbents Europe, grants from Edwards Lifesciences Germany, grants from Fresenius Medical Care, grants from Grünenthal, grants from Masimo Europe, grants from Pfizer Pharma PFE, personal fees from Georg Thieme Verlag, grants from Dr F. Köhler Chemie, grants from Sintetica, grants from Stifterverband für die deutsche Wissenschaft e.V./Philips grants from Stiftung Charité, grants from AGUETTANT Deutschland, grants from AbbVie Deutschland. KG, grants from Amomed Pharma, grants from InTouch Health, grants from Copra System, grants from Correvio, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften, grants from Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin (DGAI), grants from Stifterverband für die deutsche Wissenschaft/Medtronic, grants from Philips Electronics Nederland, grants from BMG, grants from BMBF, grants from BMBF, grants from Deutsche Forschungsgemeinschaft/German Research Society, outside the submitted work; in addition, CDS has a patent 10 2014 215 211.9 licensed, a patent 10 2018 114 364.8 licensed, a patent 10 2018 110 275.5 licensed, a patent 50 2015 010 534.8 licensed, a patent 50 2015 010 347.7 licensed and a patent 10 2014 215 212.7 licensed. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu