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Dorothy M. WADE 1, Zoe MOON 2, Sula S. WINDGASSEN 3, Anthony M. HARRISON 4, Lucy MORRIS 5, John A. WEINMAN 6
1 Critical Care Unit, University College Hospital, London, UK; 2 Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; 3 Department of Psychological Medicine, King’s College London, London, UK; 4 Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; 5 King’s College London School of Medicine, London, UK; 6 Institute of Pharmaceutical Science, King’s College London, London, UK
INTRODUCTION: Patients frequently suffer stress in intensive care units (ICUs) and many develop serious psychological morbidity after discharge. Little is known about the nature and efficacy of interventions to reduce ICU-related distress. There is growing evidence that administering sedative drugs can be harmful. Therefore we carried out a systematic review of non-pharmacological interventions to reduce ICU-related distress.
EVIDENCE ACQUISITION: A systematic search was conducted using Medline, Embase, Psychinfo, Cinahl and the Web of Science. Included studies evaluated the effect of non-pharmacological interventions to reduce ICU stress. Study populations were adults in mixed or general ICUs. Outcomes were stress or psychological distress in or after the ICU, using self-report or physiological measures. No meta-analysis was possible due to heterogeneity, therefore studies were arranged according to intervention type, and outcomes examined together with risk of bias criteria.
EVIDENCE SYNTHESIS: Twenty-three studies were eligible, including 15 randomized controlled trials. Non-pharmacological interventions included music therapy (11 studies), mind-body practices (5) and psychological interventions (7). 12 studies showed a beneficial effect. However only three of the 12 had a low risk of bias, and many studies in the review were under-powered to detect an effect. Only 5 studies measured a medium/long term psychological outcome such as PTSD or depression at 2-12 months.
CONCLUSIONS: Evidence indicates that non-pharmacological approaches to reducing ICU distress, in particular psychological interventions, may be beneficial. The evidence base would be strengthened by the implementation of fully-powered studies using robust designs, that measure longer-term outcomes.