TREATMENT AND PREVENTATIVE INTERVENTIONS FOR POST-INTENSIVE CARE SYNDROME (PICS): OVERVIEWS OF SYSTEMATIC REVIEWS

A.C. Castro-Avila^1,2, L. Jefferson¹, K. Bloor¹

Background: Patients discharged following an Intensive Care Unit (ICU) stay may experience significant physical, mental and cognitive problems after leaving the unit and once they return to their homes and communities. A comprehensive overview of the available systematic reviews assessing the effect of interventions for PICS is not yet available.

Purpose: To identify interventions to prevent and treat post-intensive care syndrome.

Methods: We searched for systematic reviews of randomised controlled trials and quasi-experimental studies assessing the effect of any intervention aimed at reducing impairments of ICU survivors in the long-term. These could be strategies in the ICU, in the hospital or the community. The effect should have been measured in terms of physical, mental or cognitive impairments after hospital discharge, except for ICU acquired weakness which is measured in-hospital. Eligible reviews included adult patients admitted to an ICU/HDU mechanically ventilated longer than 48 hrs. We searched in Medline and EMBASE from 2015 onwards until the 15th of April 2020, limiting searches to the English language. We used free text and controlled vocabulary combining terms for intensive care, long-term disabilities, treatment and preventive strategies. Records were screened and data extracted by two reviewers. The quality of identified reviews was assessed using the AMSTAR 2 checklist. A meta-analysis was planned, but clinical heterogeneity prevented us from conduct one, results are presented in a narrative synthesis.

Results: 3,980 records were identified through the search; 44 full texts were reviewed, identifying 26 eligible reviews that included 74 unique primary studies. Twenty-two reviews analysed the effect of one intervention on several outcomes, three studies focused on the effect of several interventions on one outcome, and one review included multiple interventions for different aspects of the post-intensive care syndrome. The quality of the reviews was moderate to low. Results suggest that ICU diaries and information and education interventions seem to improve caseness of anxiety and depression, ICU diaries might enhance quality of life. Follow-up services are potentially beneficial for reducing post-traumatic stress symptoms. Exercise interventions initiated in the ICU, the hospital or the community are associated with better mental health-related quality of life. Components of the interventions, measurement instruments chosen, and timing of the assessments vary greatly.

Conclusion(s): Evidence on the effectiveness of interventions for preventing or treating post-intensive care syndrome remains of low quality. Differences in the components and description of the interventions, measurement time points, and instruments used hinders conducting a quantitative synthesis. ICU diaries seem to be beneficial for reducing anxiety and depression while improving quality of life. Exercise interventions seem to enhance mental health-related quality of life.

Implications: Interventions initiated in the ICU and in-hospital for prevention of PICS should assess longer-term outcomes and adhere to current core outcome sets to improve the quality and strength of the evidence for these interventions.

Funding, acknowledgements: NIHR Policy Review Programme

Keywords: postintensive care syndrome, review of systematic reviews

Topic: Critical care

Did this work require ethics approval? No

Institution: University of York

Committee: Ethics Committee of the Department of Health Sciences

Reason: Review of the Literature