Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions
Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions
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DOI：
10.1089/jpm.2013.0409
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发表时间：
2014-02-01
影响因子：
2.8
通讯作者：
Pronovost, Peter J.
中科院分区：
文献类型：
--
作者：
Aslakson, Rebecca;Cheng, Jennifer;Pronovost, Peter J.
背景：在过去的20年里，多种干预措施，以更好地整合姑息治疗和重症监护病房（ICU）护理进行了评估。本系统综述总结了这些研究及其结果。研究方法：我们检索了MEDLINE、Embase、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、科克伦图书馆和Web of Science;检索了该领域意见领袖发表的文章;并回顾了截至2012年8月13日的手工检索文章。姑息治疗和重症监护病房这两个术语被映射到MeSH主题词中并展开。我们纳入了成年患者的试验，这些试验评估了ICU干预措施，并讨论了Robert Wood约翰逊小组确定的ICU高质量临终关怀领域。我们排除了病例系列、社论和综述文章。我们比较了两种类型的干预措施，综合和咨询，重点是病人和家属的满意度，死亡率，ICU和住院时间（LOS）的结果，因为这些是最普遍的研究。结果：我们的检索策略产生了3328篇参考文献，其中包括37篇详细介绍30种独特干预措施的出版物。干预措施和结果的措施是异质性的，许多研究的动力不足和/或受到多重偏见。大多数干预措施导致医院和ICU LOS减少。很少有干预措施显著影响满意度。除了一个例外，干预措施降低了死亡率或对死亡率没有影响。没有证据表明任何干预措施造成伤害。结论：干预措施的异质性使得比较基于ICU的姑息治疗干预措施变得困难。然而，现有的证据表明，在ICU积极的姑息治疗，使用咨询或综合姑息治疗干预，降低医院和ICU的LOS，不影响满意度，并降低或不影响死亡率。
Background: Over the last 20 years, multiple interventions to better integrate palliative care and intensive care unit (ICU) care have been evaluated. This systematic review summarizes these studies and their outcomes. Methods: We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and the Web of Science; performed a search of articles published by opinion leaders in the field; and reviewed hand-search articles as of August 13, 2012. The terms palliative care and intensive care unit were mapped to MeSH subject headings and exploded. We included trials of adult patients that evaluated an ICU intervention and addressed Robert Wood Johnson group-identified domains of high-quality end-of-life care in the ICU. We excluded case series, editorials, and review articles. We compared two types of interventions, integrative and consultative, focusing on the outcomes of patient and family satisfaction, mortality, and ICU and hospital length of stay (LOS), because these were most prevalent among studies. Results: Our search strategy yielded 3328 references, of which we included 37 publications detailing 30 unique interventions. Interventions and outcome measures were heterogeneous, and many studies were underpowered and/or subject to multiple biases. Most of the interventions resulted in a decrease in hospital and ICU LOS. Few interventions significantly affected satisfaction. With one exception, the interventions decreased or had no effect on mortality. There was no evidence of harm from any intervention. Conclusions: Heterogeneity of interventions made comparison of ICU-based palliative care interventions difficult. However, existing evidence suggests proactive palliative care in the ICU, using either consultative or integrative palliative care interventions, decrease hospital and ICU LOS, do not affect satisfaction, and either decrease or do not affect mortality.