成人加護病房介入ABCDE Bundle降低病人譫妄症狀之臨床成效評估The evaluation of clinical effectiveness of ABCDE Bundle to reduce the delirium syndrome in adult ICU patients

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2019-09-04 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

劉芝妤 劉靜如 周芳如 黃秋雯 郭素娥*

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

胸腔暨重症加護醫學 Pulmonary and Critical Care Medicine神經醫學 Neurology精神醫學 Psychiatry

科別

  • 重症護理 Critical Care Nursing

中文關鍵詞

加護病房 ABCDE 組合照護 譫妄 實證

英文關鍵詞

Intensive care units (ICU) ABCDE bundle Delirium Evidence-Based Nursing

機構名稱

臺中榮民總醫院嘉義分院

申請單位

護理部

中文摘要

形成臨床提問:
加護病房病人發生率高達八成,譫妄的發生會造成病人認知功能變差、延長住院時間、失去生活品質,甚至死亡率增加,也導致健康照護者醫療照護過程的困難度。大部分病人的譫妄是可逆性,仍有三分之一的病人的譫妄症狀會持續數月,進而提高失智症風險,造成家庭照護的困擾,也間接增加醫療負擔及照護成本。因此,如何改善加護病房病人譫妄的症狀極為重要。回顧文獻使用ABCDE bundle策略可降低成人加護病房病人譫妄症狀之成效,做為臨床應用於成人加護單位執行ABCDE bundle介入之實證參考。
文獻搜尋的方法與分析:
本文搜尋發表於國內外相關在成人加護單位介入ABCDE bundle策略措施以改善病人譫妄症狀之實證文章。搜尋資料庫包含PubMed Clinical Queries、CINAHL、The Cochrane Library、Trip、Web of Science、ProQuest和華藝等7種電子文獻資料庫,使用關鍵字:加護單位、ABCDE Bundle及譫妄等進行搜尋。初步搜尋250篇,最後瀏覽摘要及內文選擇符合納入條件與排除條件的文章,結果共有4篇類實驗的研究納入分析。
文獻的品質評讀:
四篇文獻納入評讀,選用合適之評析表JBI Critical Appraisal Checklist Tools (JBI) for Quasi-Experimental Studies進行文獻評析。評析包括9個向度,分別為清楚明確問題及效果、參與者是否有包含在類似的任何比較中、參與者是否有參與任何比較、有對照組、之前是否有多次測量結果、追蹤是否完整、兩組是否以同樣的測量方式及比較、效果有可靠方式衡量、有使用適當的統計分析等九項,納入四篇文獻評讀結果符合項目為8-9項,評析結果進一步採用Joanna Briggs Institute證據等級,納入四篇文獻證據等級為2.c。
結論與建議:
ABCDE bundle介入策略方法的四篇文獻,進行meta-analysis。結果發現ABCDE Bundle介入對加護病房病人的影響,可降低譫妄發生率0.63倍(CI: 0.45~0.90),兩組在28天存活率可增加1.13倍(CI:1.04~1.23),但在加護病房住院天數(CI: -3.36~1.68)與總住院天數(CI:-1.09~3.79)皆無顯著差異。綜合四篇文獻的ABCDE bundle策略方式,依照JBI 建議強度之評等為A 級、研究結果發現ABCDE bundle策略的期望效果超過不良效果是明確的,且具有充足品質的證據支持其使用,給於“強”建議。顯示是可以降低加護單位病人譫妄症狀。然而ABCDE bundle是屬於多專科的介入策略,需涵蓋各科專家的專業領域來共同制定標準化,以建立ABCDE bundle在成人加護病房降低病人譫妄症狀的療效。

英文摘要

Ask an answerable question (PICO):
The incidence of patients in intensive care units (ICU) is as high as 80%. The occurrence of delirium can cause decrease cognitive function, prolonged hospital stay, effects of quality of life, and increased mortality, leading to difficulties in the health care process of health care provider. Most of the patients' s delirium is reversible, Still one third of patients will continue to affect for months, which will increase the risk of dementia, caused by family caregivers of confused, and indirectly increase the medical burden and care costs. Therefore, how to improve the symptoms of delirium in intensive care units patients is extremely important. Reviewing the literature using the ABCDE bundle strategy can reduce the effectiveness of delirium symptoms in adult intensive care units, as an empirical reference for clinical application of adult care units to perform ABCDE bundle interventions.
The Method and Analysis of Literature Review:
This article searches for articles published at home and abroad related to the involvement of ABCDE bundle strategies in adult care units to improve the symptoms of delirium in patients. The search database contains seven electronic literature databases, including PubMed Clinical Queries, CINAHL, The Cochrane Library, Trip, Web of Science, ProQuest, and Airiti library. Using keywords: Care Unit, ABCDE Bundle, and delirium, a total of 250 articles that preliminary the search criteria were extracted. Finally, screening the summary and full text selection choose to match the topic, a total of 4 articles of quasi-Experimental research.
Critical Appraisal:
Four articles were included in the review, choose appropriate review form Joanna Briggs Institute Critical Appraisal Checklist Tools for Quasi-Experimental Studies was used for literature review. Is it clear in the study what is the‘cause’and what is the ‘effect , Were the participants included in any comparisons similar?, Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest?, Was there a control group?, there multiple measurements of the outcome both pre and post the intervention/exposure?, Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analyzed?, were the outcomes of participants included in any comparisons measured in the same way?, Were outcomes measured in a reliable way?, Was appropriate statistical analysis used? nine items, etc. Therefore, the results of four literature reviews are to comply with a standard with the project's 8-9 items. The results of the review were further based on the Joanna Briggs Institute's level of evidence, Inclusion four articles levels of evidence of 2.c.
Conclusions and Recommendations:
In conclusion based on the ABCDE bundle strategy approach of the four articles, meta-analysis were performed for the four studies showed that the ABCDE bundle intervention had significant effects on delirium and 28 days survival rate, with respective effect sizes of 0.63 (95% CI :0.45~0.90) and 1.13 (95% CI :1.04~1.23). There was no significant effect on ICU stays and hospital stays, with an effect size of 0.84 (95% CI :-3.36~1.68) and 1.35 (95% CI :-1.09~3.79) . According to the JBI recommended strength grade A, it is found that the expected effect of the ABCDE bundle strategy exceeds the adverse effect is clear, and there is sufficient quality evidence to support its use, giving "strong" recommend. The display can reduce the symptoms of delirium patients in the intensive unit; however the ABCDE bundle is a multidisciplinary care intervention strategy ,need that include the professional of each subject to develop standardization to establish the ABCDE bundle in the adult intensive care unit to reduce the symptoms of delirium.