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

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.