Does enhanced physical rehabilitation following intensive care unit discharge improve outcomes in patients who received mechanical ventilation? A systematic review and meta-analysis

ObjectiveWe aimed to determine whether enhanced physical rehabilitation following intensive care unit (ICU) discharge improves activities-of-daily-living function, quality of life (QOL) and mortality among patients who received mechanical ventilation in the ICU.DesignSystematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Data sourcesMEDLINE, Embase, CENTRAL, PEDro and WHO International Clinical Trials Registry Platform searched through January 2019.Eligibility criteria for selecting studiesWe included randomised controlled trials assessing the effect of post-ICU rehabilitation designed to either commence earlier and/or be more intensive than the protocol employed in the control group. Only adults who received mechanical ventilation for >24 hours were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Standard mean differences (SMDs) with 95% CIs were calculated for QOL, and pooled risk ratios (RRs) with 95% CIs are provided for mortality. We assessed heterogeneity based on I² and the certainty of evidence based on the GRADE approach.ResultsTen trials (enrolling 1110 patients) compared physical rehabilitation with usual care or no intervention after ICU discharge. Regarding QOL, the SMD (95% CI) between the intervention and control groups for the physical and mental component summary scores was 0.06 (–0.12 to 0.24) and −0.04 (−0.20 to 0.11), respectively. Rehabilitation did not significantly decrease long-term mortality (RR 1.05, 95% CI 0.66 to 1.66). The analysed trials did not report activities-of-daily-living data. The certainty of the evidence for QOL and mortality was moderate.ConclusionsEnhanced physical rehabilitation following ICU discharge may make little or no difference to QOL or mortality among patients who received mechanical ventilation in the ICU. Given the wide CIs, further studies are needed to confirm the efficacy of intensive post-ICU rehabilitation in selected populations.PROSPERO registration numberCRD42017080532.

Download Full-text

The effect of physical rehabilitation on activities of daily living in older residents of long-term care facilities: systematic review with meta-analysis

Age and Ageing ◽

10.1093/ageing/aft133 ◽

2013 ◽

Vol 42 (6) ◽

pp. 682-688 ◽

Cited By ~ 34

Author(s):

Tom Crocker ◽

John Young ◽

Anne Forster ◽

Lesley Brown ◽

Seline Ozer ◽

...

Keyword(s):

Systematic Review ◽

Activities Of Daily Living ◽

Daily Living ◽

Long Term Care ◽

Meta Analysis ◽

Physical Rehabilitation ◽

Term Care ◽

Care Facilities

Download Full-text

Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

Critical Care ◽

10.1186/s13054-016-1396-0 ◽

2016 ◽

Vol 20 (1) ◽

Cited By ~ 10

Author(s):

Lei Guo ◽

Weiwei Wang ◽

Nana Zhao ◽

Libo Guo ◽

Chunjie Chi ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Acute Lung Injury ◽

Lung Injury ◽

Distress Syndrome ◽

Meta Analysis ◽

Ventilation Strategies

Download Full-text

Faculty Opinions recommendation of The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717953729.793459343 ◽

2012 ◽

Author(s):

Mark Wainwright

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Clinical Studies ◽

Meta Analysis ◽

Confusion Assessment Method ◽

Assessment Method ◽

Confusion Assessment

Download Full-text

Faculty Opinions recommendation of Safety of Patient Mobilization and Rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727337857.793558842 ◽

2019 ◽

Author(s):

Nicola Latronico

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Meta Analysis

Download Full-text

Faculty Opinions recommendation of Risk factors for intensive care unit-acquired weakness: A systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733323784.793558835 ◽

2019 ◽

Author(s):

Nicola Latronico

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Meta Analysis

Download Full-text

Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: A meta‐analysis of randomized controlled trials

International Journal of Nursing Practice ◽

10.1111/ijn.12948 ◽

2021 ◽

Author(s):

Ting‐Jhen Chen ◽

Yi‐Wei Chung ◽

Pin‐Yuan Chen ◽

Sophia H. Hu ◽

Chuen‐Chau Chang ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Daily Sedation Interruption

Download Full-text

Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

Anaesthesia and Intensive Care ◽

10.1177/0310057x20962113 ◽

2021 ◽

Vol 49 (1) ◽

pp. 23-34

Author(s):

Katherine P Hooper ◽

Matthew H Anstey ◽

Edward Litton

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Meta Analysis ◽

Diagnostic Testing ◽

Intervention Group ◽

Cochrane Central Register ◽

Safety And Efficacy ◽

Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

Download Full-text