家人數位影音參與模式改善加護病房病人譫妄之成效

Effects of a Simulated Family Presence Program on ICU Delirium

實施譫妄預防措施為提高重症單位醫護品質之重要任務。以系統性文獻回顧及整合所選取的隨機對照試驗，確認家人使用數位影音參與對加護病房病人譫妄的改善成效。設立關鍵字，並搭配自然語言及MeSH term於8個資料庫（包括PubMed, CINAHL, Cochrane Library, MEDLINE, ProQuest, Embase, 華藝, and國家學位論文數位圖書館）進行搜尋2021年5月前的中英文文獻，總共發現58篇文獻，經篩選、排除重複文獻後，最終納入2篇符合主題之文章，並以GRADE及CASP隨機對照試驗評讀工具檢測證據品質。2篇研究共141位病人，樣本數範圍為30至111人，結果發現介入家庭影片可改善病人的躁動情形；而介入家人錄音檔之研究結果發現，三組平均無譫妄天數達顯著差異（p=0.04），以介入家人錄音檔組無譫妄天數顯著高於其他兩組。錄製有意義的家人影音或聲音介入模式，確實能改善病人躁動或預防譫妄發生，因此，建議臨床應善用錄製1-2分鐘病人家屬的客製化訊息或影音，融入於臨床常規中並於24小時內實施，將有助於醫療團隊有效地預防加護病房病人譫妄問題，及提升照護品質。

Conducting a comprehensive assessment and delirium prevention program for patients in the intensive care unit (ICU) is an important task for improving the quality of care in the ICU. We aimed to perform a systematic review of randomized controlled trials to evaluate the effects of family video messaging on ICU delirium. The following keywords with natural language system and MeSH terms were used to search for articles on family voice, recorded audio messages, delirium and agitation. Articles were retrieved from 8 electronic databases including PubMed, CINAHL, Cochrane Library, MEDLINE, ProQuest, EMBASE, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan. A total of 58 articles published prior to May 2021 met the search criteria. After screening the abstract, title, and main text of the studies and deleting repetitions, we identified two eligible trials for qualitative synthesis. Research quality was appraised using the GRADE and CASP-RCT checklist. Two studies had a total of 141 patients, and the sample size ranged from 30 to 111. The results of family video study revealed that family video messaging may decrease agitation in delirious patients. In another study using family voice, thirty ICU patients were randomized to 3 groups (family voice group, non-family voice group and the control group). The results showed that the family voice group significantly had more delirium free days than the other groups (p=0.04). Recording 1-2 minutes meaningful video or audio interventions can improve patient agitation or reduce delirium. Therefore, it is recommended to use recorded customized messages or video from the patient's family members and integrate them into clinical routines within 24 hours of admission to help the medical team prevent delirium more effectively and improve the quality of care.