Using Qualitative Synthesis to Explore Heterogeneity of Randomized Trials on ICU Diaries*

Abstract

Objective: We aimed to identify which set of components differentiates the ICU diaries that were effective in reducing psychologic symptoms after critical illness. Data Sources: We searched the online databases MEDLINE, OVID, Embase, and EBSCOhost from inception to December 2021. Study Selection: Randomized controlled trials (RCTs) of the ICU diary were included, irrespective of the language, with samples of adult patients (≥ 18 yr old) and/or their relatives hospitalized in an ICU for more than 24 hours. Two qualitative syntheses on patients’ and healthcare providers’ perceptions on the ICU diary were included. Data Extraction: Four findings were extracted from the qualitative synthesis of patients’ perspectives on the ICU diary. From the RCTs, we extracted the components of the ICU diary and whether the patients were ventilated for at least 3 days. We reported the outcome as effective or not, regardless of the psychiatric symptoms and diagnostic tools used for evaluation. We built a matrix in which each column represented a recommendation for an intervention component derived from the qualitative review, and each row represented whether the components of an individual trial’s intervention matched any of the recommendations. Data Synthesis: Eight RCTs were included in the final analysis. The sample of five studies consisted of patients under mechanical ventilation (MV) for at least 3 days. Two were positive trials. Three RCTs included family members, and two of those were positive trials. CONCLUSIONS: For patients under MV for at least 3 days, the ICU diaries that were effective in preventing psychiatric symptoms after critical illness were written by the ICU staff, delivered after hospital discharge, and read with a healthcare professional in order to better understand the diary and the ICU stay. For family members, the presence of photographs was the only characteristic identified a successful ICU diary.

ICU Diaries: A Useful Tool in the Reduction of Psychiatric Symptoms After Critical Illness*

“…A follow-up study by the same authors in 2021 not only concluded positive impressions by patients, family, and staff members related to the use of ICU diaries but also noted that time pressure of ICU staff members writing in diaries may be an overall obstacle for staff diary entries (Barreto et al [11]). Both articles cited above as well as that of Brandao Barreto et al (9) show positive patient and family outcomes with the use of ICU diaries for patients on ventilators. All three studies used existing data from online databases such as PubMed, MEDLINE, OVID, Embase, and EBSCOhost.…”

“…What is most useful from the study by Brandao Barreto et al (9) is the critique the authors give for ongoing use and evaluation of ICU diaries in general and suggestions on how to improve the data from the diary information. Quality improvement suggestions include the need for standardizing the ICU diary process, which would allow for comparison studies on this topic for generalizability as well as for variant differences.…”

“…In this issue of Critical Care Medicine , Brandao Barreto et al (9) provide evidence that health diaries, used with patients who have been in an ICU for more than 24 hours and who were on mechanical ventilation, may show positive health benefits in the prevention of psychiatric symptoms after critical illness. The article (9) “Using qualitative synthesis to explore heterogeneity of randomized trials on ICU diaries” discusses the authors’ review of five qualitative studies of ICU patients under mechanical ventilation from which eight patients, called random controlled trial by the authors, were reviewed for their study ICU diary data. The overall aim of the study by Brandao Barreto et al (9) was to identify the various components of the ICU diaries that were associated in the reduction of psychologic symptoms after critical illness.…”

“…The article (9) “Using qualitative synthesis to explore heterogeneity of randomized trials on ICU diaries” discusses the authors’ review of five qualitative studies of ICU patients under mechanical ventilation from which eight patients, called random controlled trial by the authors, were reviewed for their study ICU diary data. The overall aim of the study by Brandao Barreto et al (9) was to identify the various components of the ICU diaries that were associated in the reduction of psychologic symptoms after critical illness.…”

“…Entries might include pictures and factual accounts of what was going on with the patient medically or interactively with staff and family members while the patient was sedated and on the ventilator. The overall goal of the diaries was to “provide patients with a factual account of the ICU stay, in order to fill in memory aps, promoting a better understanding of he critical illness they survived” (9). The authors note that ICU-related posttraumatic stress disorder (PTSD) is associated with delusional memories by the patient and the use of a factual diary will reassure patients and reduce possible associated PTSD.…”