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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

What type of monitoring has been shown to improve outcomes in acutely ill patients?

GA Ospina-Tascon, RL Cordioli, and JL Vincent.

Review published: 2008.

CRD summary

This review assessed the impact of monitoring systems on outcomes in acutely ill patients. There was no evidence that monitoring systems improved outcomes in the intensive care unit. Commonly used techniques have not been evaluated in RCTs. Despite reflecting the evidence presented, the reliability of the conclusions is unclear given a number of methodological weaknesses.

Authors' objectives

To evaluate the impact of monitoring systems on outcomes in acutely ill patients and in perioperative patients undergoing major procedures.

Searching

The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE were searched from inception to June 2006, without restriction. The search strategy was available online as supplementary material (see URL for Additional Data).

Study selection

Randomised controlled trials (RCTs) that compared a monitored group of patients with a non-monitored control, or where the health care providers were unaware of monitoring measurements, were eligible for inclusion. Only monitoring systems in critically ill and perioperative adults undergoing major procedures were considered. Paediatric studies and those assessing the impact of medicaments or therapies on measurements obtained by a monitoring system were excluded. Outcomes of interest were morbidity, mortality, optimisation of therapeutic strategies, complications, costs and quality of life.

Monitoring techniques evaluated in the included trials were haemodynamic and perfusion, respiratory, and neurological monitoring systems. Further details regarding the specific techniques are reported in the paper. Included trials were of patients with a broad range of conditions (most commonly hip fracture, or cardiac illness) using respiratory, neurological, and/or haemodynamic and perfusion monitoring procedures.

Two reviewers independently assessed studies for inclusion. Disagreements were resolved by consensus.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Two reviewers independently extracted data using a standardised form. Disagreements were resolved through consensus.

Methods of synthesis

The trials were described narratively, grouped into a range of monitoring systems (haemodynamic and perfusion, respiratory, and neurological) and further classified according to impacts on outcomes (positive or neutral). Tables were used to summarise trial characteristics.

Results of the review

Sixty-seven RCTs were included (n=39,870 participants).The number and sample sizes of RCTs evaluating the included monitoring systems were varied: haemodynamic and perfusion monitoring (40 RCTs, n=9,779 participants, range 33 to 1,994), respiratory monitoring (17 RCTs, n=24,609 participants, range 24 to 20,802), and neurological monitoring (10 RCTs, n=5,482 participants, range 30 to 2,463).

Haemodynamic and perfusion monitoring: Positive mortality outcomes were observed in 10 of the 31 trials that evaluated mortality. Positive non-mortality outcomes were observed in 17 of the 40 trials.

Respiratory monitoring: Positive mortality outcomes were observed in three of the 7 trials that evaluated mortality. Positive non-mortality outcomes were observed in 11 of the 17 trials.

Neurological monitoring: Positive non-mortality outcomes were observed in all the studies. None of the trials evaluated mortality.

Metabolic monitoring: No trials assessing the impact of metabolic monitoring were identified.

Cost information

Neutral cost impact was observed in two haemodynamic and perfusion monitoring trials that evaluated hospital costs.

Authors' conclusions

There was no broad evidence that any form of monitoring improved outcomes in the intensive care unit. The most commonly used devices have not been evaluated by RCTs.

CRD commentary

The review inclusion criteria were clearly specified. The authors searched only two databases and no searches appear to have been made to identify unpublished studies, so it is possible that relevant studies were missed. Steps were taken to minimise the potential for reviewer error and bias through duplicate study selection and data abstraction. The validity of the reported findings was unclear as there was no assessment of study quality; quality assessment may have enabled a more focused synthesis of results. The authors’ decision not to pool trials in a meta-analysis was justified given the apparent differences between trials. Given the limitations in the review process, the reliability of the conclusions is unclear and the reported effects should be treated with caution.

Implications of the review for practice and research

The authors did not state any implications for practice or further research.

Funding

Not stated.

Bibliographic details

Ospina-Tascon GA, Cordioli RL, Vincent J L. What type of monitoring has been shown to improve outcomes in acutely ill patients? Intensive Care Medicine 2008; 34(5): 800-820. [PubMed: 18183364]

Indexing Status

Subject indexing assigned by NLM

MeSH

Acute Disease; Adult; Critical Illness; Diagnostic Techniques, Cardiovascular /instrumentation; Diagnostic Techniques, Neurological /instrumentation; Humans; Monitoring, Physiologic /instrumentation /methods; Randomized Controlled Trials as Topic; Respiratory Function Tests /instrumentation /methods; Survival Analysis; Treatment Outcome

AccessionNumber

12008106626

Database entry date

02/12/2009

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 18183364

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