Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis

TY - JOUR

T1 - Impact of follow-up consultations for ICU survivors on post-ICU syndrome

T2 - a systematic review and meta-analysis

AU - Jensen, J. F.

AU - Thomsen, Thordis

AU - Overgaard, D

AU - Bestle, Morten Heiberg

AU - Christensen, Doris

AU - Egerod, I

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Purpose: To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors. Methods: Systematic literature review from five databases (Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL), reference lists, citation tracking, and ongoing/unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed quality independently. The mean differences, risk ratios, and 95 % confidence intervals were calculated depending on outcome measures. Results: From 1544 citations, five trials were included (855 patients). The overall risk of bias was low in two trials, unclear in two trials, and high in one trial. The overall quality of evidence was low. The trials assessed follow-up interventions defined as consultations informing survivors about their ICU stay. One trial found no effect on QOL. Pooling data from two trials (n = 374) showed a protective effect on risk of new onset PTSD at 3–6 months after ICU (risk ratio 0.49, 95 % CI 0.26–0.95). There was no effect on other outcomes. Conclusions: The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3–6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.

AB - Purpose: To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors. Methods: Systematic literature review from five databases (Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL), reference lists, citation tracking, and ongoing/unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed quality independently. The mean differences, risk ratios, and 95 % confidence intervals were calculated depending on outcome measures. Results: From 1544 citations, five trials were included (855 patients). The overall risk of bias was low in two trials, unclear in two trials, and high in one trial. The overall quality of evidence was low. The trials assessed follow-up interventions defined as consultations informing survivors about their ICU stay. One trial found no effect on QOL. Pooling data from two trials (n = 374) showed a protective effect on risk of new onset PTSD at 3–6 months after ICU (risk ratio 0.49, 95 % CI 0.26–0.95). There was no effect on other outcomes. Conclusions: The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3–6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anxiety

KW - Cognition

KW - Critical Care

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Outcome Assessment (Health Care)

KW - Quality of Life

KW - Stress Disorders, Post-Traumatic

KW - Survivors

U2 - 10.1007/s00134-015-3689-1

DO - 10.1007/s00134-015-3689-1

M3 - Journal article

C2 - 25731633

SN - 0342-4642

VL - 41

SP - 763

EP - 775

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 5

ER -