Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis.

Purpose: To evaluate the evidence for an effect of systematic follow-up consultations versus standard care for intensive care recovery.
Methods: Systematic literature search in five databases (Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL), reference lists, citation tracking, and ongoing/unpublished trials. Randomized controlled trials investigating post intensive care unit (ICU) consultations in adults with outcomes of quality of life (QOL), anxiety, depression, post-traumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed quality independently. The mean differences, risk ratios and 95 % confidence intervals were calculated depending on outcome measures.
Results: From 1544 citations, five trials were included (n=855). In these five trials the risk of bias was low in three trials, unclear in one trial, and high in one trial. The overall quality of evidence was low. The trials assessed follow-up interventions defined as consultations informing survivors about their ICU stay. One trial found no effect on QOL. Pooling data from two trials (n=374) showed a protective effect on risk of new onset PTSD between 3-6 months after ICU (Risk Ratio 0.49, 95% CI 0.26 to 0.95). There was no effect on other outcomes.
Conclusions: The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3-6 months after ICU discharge in ICU-survivors, however without affecting QOL and other outcomes investigated. Follow-up interventions need to be developed in collaboration with intensive care survivors, and the effect should be evaluated in large-scale RCTs.