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

Abstract

Purpose: The present systematic review and meta-analysis aimed to synthesize data on subject outcomes associated with post-ICU follow-up.

Materials and methods: MEDLINE, 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.

Results: Twenty-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 = 0%) and better mental health-related quality of life scores (standardized MD [SMD], 0.26; 95%CI, 0.02 to 0.51; I² = 6%) 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 = 0%) in the medium term.

Conclusions: Post-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.

Keywords: After care; Anxiety; Depression; Intensive care; Physical functional performance; Quality of life; Rehabilitation; Stress disorders, posttraumatic.