PRISMA 2020 Main Checklist
No
Topic Item Location where item is reported
.
TITLE
Title 1 Identify the report as a Effectiveness of Bundle Interventions on ICU
systematic review. Delirium: A Meta-Analysis*
ABSTRACT
Abstract 2 See the PRISMA 2020 for
Abstracts checklist
INTRODUCTION
Rationale 3 Describe the rationale for It has been proposed that the ABCDEF bundle
the review in the context maybe more effective than any single-
of existing knowledge. component strategy in preventing and
managing ICU delirium
with its evidence largely driven from before-
after stud- ies (10–13) or pilot studies (14,
15). After the PADIS Guidelines were
released, a number of well-designed robust
randomized clinical trials (RCTs) (16–18) have
been conducted to evaluate the bundle
interventions in minimizing modifiable risk
factors related to ICU delirium, therefore
reducing its prevalence or dura- tion.
However, their findings have been
inconsistent or even contradictory among
different studies (19–21).
Objectives 4 Provide an explicit Therefore, we conducted a meta-analysis to
statement of the assess the overall effectiveness of bundle
objective(s) or interventions on the prevalence and duration
question(s) the review of ICU delirium, and other important adverse
addresses. outcomes, such as the hospital length of stay
(LOS) and mortality.
METHODS
1
, No
Topic Item Location where item is reported
.
Eligibility 5 Specify the inclusion and Articles were eli- gible for inclusion in the
criteria exclusion criteria for the meta-analysis if they met all of the following
review and how studies inclusion criteria: 1) RCTs or cohort stud- ies,
were grouped for the (the Cochrane Handbook for Systematic
syntheses. Reviews of Interventions, Version 6.0 [24],
identifies that the re- view may include
nonrandomized studies, such as co- hort
studies, when the question of interest cannot
be answered by RCTs), 2) study participants
were adults (18 years old or older)
administered in the ICUs, and 3) application
of at least three of the components identified
in the ABCDEF bundle, which includes
assessment and pain management, SAT or
SAT plus SBT for patients supported by
ventilator, choice of analgesia and seda- tion,
delirium monitoring/management, early
exercise/ mobility, and family engagement
and empowerment. Articles were excluded if
they were presented with any of the following
reasons: 1) nonrelevant topics, 2) study
protocols or case reports, 3) commentary or
meta-anal- ysis and systemic review, and 4)
nonhuman study. For articles that met the
above initial criteria, the following second-
level inclusion criteria were applied: 1) study
must be designed with control groups, 2) ICU
delirium was measured by validated
instruments including the diagnostic and
statistical methods IV criteria, confu- sion
assessment method (CAM), CAM for the ICU
(CAM-ICU), or the intensive care delirium
screening checklist (ICDSC), and 3) the study
reported selected clinical outcomes of our
interest (Fig. 1).
Information 6 Specify all databases, Databases including the Cochrane Library,
sources registers, websites, PubMed, CINAHL, EMBASE, PsychINFO, and
organisations, reference MEDLINE were searched for published articles
lists and other sources with no language restriction applied.
searched or consulted to
identify studies. Specify
the date when each
source was last searched
or consulted.
2
, No
Topic Item Location where item is reported
.
Search strategy 7 Present the full search The search terms included a combination of
strategies for all key terms related to delirium: (delirium OR
databases, registers and confusion OR acute confusional syndrome OR
websites, including any postoperative de- lirium OR cognitive
filters and limits used. dysfunction OR ICU delirium OR ICU psychosis
OR ICU syndrome OR deliri*) AND (ABCDE
bundle OR ABCDEF bundle OR bundle OR PAD
OR critical care* OR intensive care* OR
preven- tion OR intervention). We also
searched ongoing and unpublished trials
using the clinicaltrials.gov data- bases.
Additional relevant articles were identified by
manually reviewing the reference lists of all
included research articles as well as
published review articles and meta-analyses.
The authors of original studies were also
contacted to acquire missed data to be in-
cluded in the final analysis.
Selection 8 Specify the methods The title and abstract of all articles were
process used to decide whether a screened ini- tially, and the full text of
study met the inclusion potential studies was retrieved and further
criteria of the review, reviewed by two reviewers (S.Z. and Y.H.)
including how many independently to assess the eligibility.
reviewers screened each
record and each report
retrieved, whether they
worked independently,
and if applicable, details
of automation tools used
in the process.
Data collection 9 Specify the methods Using a predesigned standardized data-
process used to collect data from collection form, relevant data from original
reports, including how studies were extracted and collected
many reviewers collected independently by two researchers (S.Z. and
data from each report, Y.H.), including study characteristics (primary
whether they worked au- thor, publication year, study design, and
independently, any sample size), participant demographics (age
processes for obtaining and gender), interven- tions and
or confirming data from comparisons, as well as information on the
study investigators, and intended outcome variables. For each
if applicable, details of outcome, the reviewers extracted the means
automation tools used in (sds) of the variable or number of patients in
the process. each study.
3
No
Topic Item Location where item is reported
.
TITLE
Title 1 Identify the report as a Effectiveness of Bundle Interventions on ICU
systematic review. Delirium: A Meta-Analysis*
ABSTRACT
Abstract 2 See the PRISMA 2020 for
Abstracts checklist
INTRODUCTION
Rationale 3 Describe the rationale for It has been proposed that the ABCDEF bundle
the review in the context maybe more effective than any single-
of existing knowledge. component strategy in preventing and
managing ICU delirium
with its evidence largely driven from before-
after stud- ies (10–13) or pilot studies (14,
15). After the PADIS Guidelines were
released, a number of well-designed robust
randomized clinical trials (RCTs) (16–18) have
been conducted to evaluate the bundle
interventions in minimizing modifiable risk
factors related to ICU delirium, therefore
reducing its prevalence or dura- tion.
However, their findings have been
inconsistent or even contradictory among
different studies (19–21).
Objectives 4 Provide an explicit Therefore, we conducted a meta-analysis to
statement of the assess the overall effectiveness of bundle
objective(s) or interventions on the prevalence and duration
question(s) the review of ICU delirium, and other important adverse
addresses. outcomes, such as the hospital length of stay
(LOS) and mortality.
METHODS
1
, No
Topic Item Location where item is reported
.
Eligibility 5 Specify the inclusion and Articles were eli- gible for inclusion in the
criteria exclusion criteria for the meta-analysis if they met all of the following
review and how studies inclusion criteria: 1) RCTs or cohort stud- ies,
were grouped for the (the Cochrane Handbook for Systematic
syntheses. Reviews of Interventions, Version 6.0 [24],
identifies that the re- view may include
nonrandomized studies, such as co- hort
studies, when the question of interest cannot
be answered by RCTs), 2) study participants
were adults (18 years old or older)
administered in the ICUs, and 3) application
of at least three of the components identified
in the ABCDEF bundle, which includes
assessment and pain management, SAT or
SAT plus SBT for patients supported by
ventilator, choice of analgesia and seda- tion,
delirium monitoring/management, early
exercise/ mobility, and family engagement
and empowerment. Articles were excluded if
they were presented with any of the following
reasons: 1) nonrelevant topics, 2) study
protocols or case reports, 3) commentary or
meta-anal- ysis and systemic review, and 4)
nonhuman study. For articles that met the
above initial criteria, the following second-
level inclusion criteria were applied: 1) study
must be designed with control groups, 2) ICU
delirium was measured by validated
instruments including the diagnostic and
statistical methods IV criteria, confu- sion
assessment method (CAM), CAM for the ICU
(CAM-ICU), or the intensive care delirium
screening checklist (ICDSC), and 3) the study
reported selected clinical outcomes of our
interest (Fig. 1).
Information 6 Specify all databases, Databases including the Cochrane Library,
sources registers, websites, PubMed, CINAHL, EMBASE, PsychINFO, and
organisations, reference MEDLINE were searched for published articles
lists and other sources with no language restriction applied.
searched or consulted to
identify studies. Specify
the date when each
source was last searched
or consulted.
2
, No
Topic Item Location where item is reported
.
Search strategy 7 Present the full search The search terms included a combination of
strategies for all key terms related to delirium: (delirium OR
databases, registers and confusion OR acute confusional syndrome OR
websites, including any postoperative de- lirium OR cognitive
filters and limits used. dysfunction OR ICU delirium OR ICU psychosis
OR ICU syndrome OR deliri*) AND (ABCDE
bundle OR ABCDEF bundle OR bundle OR PAD
OR critical care* OR intensive care* OR
preven- tion OR intervention). We also
searched ongoing and unpublished trials
using the clinicaltrials.gov data- bases.
Additional relevant articles were identified by
manually reviewing the reference lists of all
included research articles as well as
published review articles and meta-analyses.
The authors of original studies were also
contacted to acquire missed data to be in-
cluded in the final analysis.
Selection 8 Specify the methods The title and abstract of all articles were
process used to decide whether a screened ini- tially, and the full text of
study met the inclusion potential studies was retrieved and further
criteria of the review, reviewed by two reviewers (S.Z. and Y.H.)
including how many independently to assess the eligibility.
reviewers screened each
record and each report
retrieved, whether they
worked independently,
and if applicable, details
of automation tools used
in the process.
Data collection 9 Specify the methods Using a predesigned standardized data-
process used to collect data from collection form, relevant data from original
reports, including how studies were extracted and collected
many reviewers collected independently by two researchers (S.Z. and
data from each report, Y.H.), including study characteristics (primary
whether they worked au- thor, publication year, study design, and
independently, any sample size), participant demographics (age
processes for obtaining and gender), interven- tions and
or confirming data from comparisons, as well as information on the
study investigators, and intended outcome variables. For each
if applicable, details of outcome, the reviewers extracted the means
automation tools used in (sds) of the variable or number of patients in
the process. each study.
3
