Rapid evidence synthesis for COVID-19 international guidance: a World Health Organization commissioned Cochrane rapid scoping review
2School of Nursing and Midwifery, University of Galway, and Evidence Synthesis Ireland, Ireland
3University College Dublin, Dublin, Ireland
4Cork University Hospital, Cork, Ireland
COVID-19, for some people, can result in admission to the intensive care unit (ICU). Care bundles, a small set of evidence-based interventions, delivered together consistently, may improve patient outcomes. To inform international guidelines, the World Health Organization (WHO) commissioned a Cochrane scoping review to identify the type of evidence on care bundles in patients with COVID-19 in the ICU. The review was conducted rapidly over a three-week period in 2020.
Objectives: To present the conduct and findings of this scoping review and describe how international collaborative activity helped produce quality evidence rapidly during COVID-19.
Methods: The JBI Manual for Evidence Synthesis (Chapter 11) and Cochrane Rapid Reviews Methods Group were consulted in conducting the review. Studies of all designs that reported on the use of a care bundle in people with COVID-19, or a related condition, in the ICU were eligible for inclusion. MEDLINE, Embase, the Cochrane Library, and the WHO-ICTRP were searched in October 2020. The review outcomes included mortality, length of ICU stay, days of ventilation, and rates of adherence to the care bundle. As this was a scoping review, the methods did not involve assessing intervention effectiveness, risk of bias, or the certainty of the evidence. The extracted data were mapped and presented in tabular and graphic format.
Results: We included 21 studies of variable designs, involving over 2000 patients. The care bundles involved diverse practices, including guidance on ventilator settings (10 studies), restrictive fluid management (8 studies), sedation (7 studies), and prone positioning (7 studies). Fourteen studies reported on mortality, nine on days of ventilation, nine on length of ICU stay, and three reported on bundle adherence. Identified evidence gaps included a lack of care bundles for preparing patients to leave the ICU and for long-term COVID-19 effects.
Conclusions: Information on care bundles specific to patients with COVID-19 in the ICU is limited. Good communication and collaboration ensured the timely conduct of this rapid scoping review in advance of WHO guideline development meetings. Taking methodologically sound decisions, and at what stages, were required to balance speed and quality in an era of rapid evidence need.