Comparison of the clinical features in open and closed format intensive care units: A systematic review and meta-analysis

Abstract

ImportanceThe difference in clinical outcomes between closed and open designs of intensive care units (ICUs) is still an open question. ObjectiveWe conducted a systematic review and meta-analysis to compare total mortality, hospital and ICU length of stay (LOS) and mortality as primary outcomes, and severity of illness based on physiological variables, organ failure assessment, age, duration of mechanical ventilation and ventilator-associated pneumonia frequency as secondary outcomes in closed and open ICUs. Evidence reviewMedline, PubMed, Scopus, Web of Science, Cochrane database, Iran-doc and Elm-net according to the MeSH terms were searched from 1988 to October 2019. The standardised mean difference (SMD), relative risk (RR) with 95% confidence interval (CI) were applied to display summary statistics of primary and secondary outcomes. FindingsA total of 90 studies with 444,042 participants were analysed. ICU mortality (RR: 1.16, CI: 1.07–1.27, p < 0.001), hospital mortality (RR: 1.12, CI: 1.03–1.22, p = 0.010) and ICU LOS (SMD: 0.43, CI: 0.01−0.85, p = 0.040) were significantly higher in open ICUs. Total mortality (RR: 0.91, CI: 0.77–1.08, p = 0.28) and hospital LOS (SMD: 1.14, CI: 1.31–3.59, p = 0.36) showed no significant difference between the two types of ICU. The secondary outcome measures were also comparable between the two ICU formats (p > 0.05). Conclusions and relevanceThe results demonstrated superiority of closed versus open ICUs in hospital and ICU mortality rates and ICU LOS, with no difference in total mortality, hospital LOS or severity of illness parameters. The superiority of the closed ICU format may be a result of the intensivist-led patient care and should therefore be implemented by clinicians to decrease ICU mortality rates and LOS for critically ill patients.