Effects of post-ICU follow-up on subject outcomes: A systematic review and meta-analysis.

Abstract

PURPOSE\nThe present systematic review and meta-analysis aimed to synthesize data on subject outcomes associated with post-ICU follow-up.\n\n\nMATERIALS AND METHODS\nMEDLINE, PsycINFO, CINAHL, Cochrane CENTRAL, and EMBASE databases were searched according to pre-specified criteria (PROSPERO- CRD42017074734). Non-randomized and randomized studies assessing patient and family outcomes associated with post-ICU follow-up were included.\n\n\nRESULTS\nTwenty-six studies were included. Sixteen (61%) were randomized trials; of these, 15 were meta-analyzed. Non-randomized studies reported benefits in survival, functional status, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms, and satisfaction. In randomized trials, post-ICU follow-up models focusing on physical therapy were associated with fewer depression symptoms (mean difference [MD], -1.21 (see Fig. 2); 95% confidence interval [CI], -2.31 to -0.11; I2\u202f=\u202f0%) and better mental health-related quality of life scores (standardized MD [SMD], 0.26; 95%CI, 0.02 to 0.51; I2\u202f=\u202f6%) in the short term. Post-ICU follow-up models focusing on psychological or medical management interventions were associated with fewer PTSD symptoms (SMD, -0.21; 95%CI, -0.37 to -0.05; I2\u202f=\u202f0%) in the medium term.\n\n\nCONCLUSIONS\nPost-ICU follow-up may improve depression symptoms and mental health-related quality of life in the short term for models focusing on physical therapy and PTSD symptoms in the medium term for models focusing on psychological or medical management interventions.