ABCDE bundle介入對加護病房病人譫妄之成效——系統性回顧暨統合分析

Effects of ABCDE bundle on incidence of delirium among critically ill patients in intensive care unit: a systematic review and meta-analysis

目標：譫妄為加護病房病人常見的合併症，發生率高達八成。國外自2014開始實施ABCDE組合照護（ABCDE bundle）預防譫妄，但歐、亞及國內較少相關研究，也缺乏系統性文獻整合與回顧其成效，本文旨在探討ABCDE bundle介入對加護病房病人譫妄之成效。方法：此研究於PubMed Clinical Queries、CINAHL、The Cochrane Library、Trip、Web of Science、ProQuest和華藝線上圖書館等7種電子文獻資料庫設定關鍵字，搜尋2020年12月以前出版之中、英文文獻，依據納入及排除條件後共納入4篇文獻。依JBI類實驗法評讀工具評價文章品質，發現效果明確超過不良效果，具備充足品質的證據支持，給予“強”建議，並使用Review Manager軟體（RevMan）5.3版本進行統合分析。結果：統合分析顯示ABCDE bundle介入可有效地降低譫妄發生率（RR: 0.63； CI:0.45~0.90），並可提高13%的28天存活率（RR: 1.13； CI: 1.04~1.23）。結論：ABCDE bundle對加護病房的譫妄預防及存活率具實證基礎。此結果可提供醫療人員給予加護病房病人多元整合照護之參酌；但受限於研究多為類實驗設計且較少歐亞研究，建議未來投入更多及更嚴謹的在地臨床隨機控制研究。（台灣衛誌2021；40(1)：71-82）

Objectives: Delirium is a common complication in patients in the intensive care unit, with a high incidence of up to 80%. The ABCDE (Awakening, Breathing, Coordination, Delirium monitoring/management, and Early exercise/mobility) bundle care model has been implemented to prevent delirium in the United States since 2014, but only few relevant studies have been conducted in Europe, Asian countries and Taiwan. Moreover, a systematic literature review and meta-analysis of its efficacy is lacking. Methods: This meta-analysis used defined keywords to search for quantitative studies published in Chinese or English before December 2020 in seven electronic literature databases. Four articles were included after applying the inclusion and exclusion criteria. The Joanna Briggs Institute (JBI) quasi-experiment appraisal tools were used to evaluate the quality of these articles. Data were analyzed using the RevMan version 5.3 software. Results: The JBI appraisal was level of evidence 2c, indicating strong evidence. The meta-analysis revealed that the ABCDE bundle could effectively lower the incidence of delirium (relative risk [RR], 95% confidence interval [CI]: 0.63, 0.45-0.90) and incidental benefit increase the 28-day survival rate by 13% (1.13, 1.04-1.23). Conclusions: The use of the ABCDE bundle to prevent delirium and improve survival in patients in the critical care unit is supported by evidence. The results may serve as a reference for health-care professionals who provide interdisciplinary care. However, this study is limited by its quasi-experimental design and the lack of studies in Eurasia and Taiwan. Further studies with a stringent design (RCT) are recommended to investigate this topic in depth. (Taiwan J Public Health. 2021;40(1):71-82)