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Care bundles for improving outcomes in patients with COVID‐19 or related conditions in intensive care – a rapid scoping review, Cochrane Library

Cochrane Library
Year of publication

Main results

We included 21 studies and identified three ongoing studies. The studies were of variable designs and included a systematic review of standardised approaches to caring for critically ill patients in ICU, including but not exclusive to care bundles (1 study), a randomised trial (1 study), prospective and retrospective cohort studies (4 studies), before and after studies (7 studies), observational quality improvement reports (4 studies), case series/case reports (3 studies) and audit (1 study). The studies were conducted in eight countries, most commonly China (5 studies) and the USA (4 studies), were published between 1999 and 2020, and involved over 2000 participants in total.

Studies categorised participant conditions patients with confirmed or suspected COVID19 (7 studies), patients with ARDS (7 studies), patients with another influenza or viral pneumonia (5 studies), patients with severe respiratory failure (1 study), and patients with mixed conditions (1 study).

The care bundles described in the studies involved multiple diverse practices. Guidance on ventilator settings (10 studies), restrictive fluid management (8 studies), sedation (7 studies) and prone positioning (7 studies) were identified most frequently, while only one study mentioned chest Xray.


None of the included studies reported the prespecified outcomes ICUacquired weakness (muscle wasting, weight loss) and users' experience adapting care bundles.


Of the remaining prespecified outcomes, 14 studies reported death in ICU, nine reported days of ventilation (or ventilatorfree days), nine reported length of stay in ICU in days, five reported death in hospital, three reported length of stay in hospital in days, and three reported adherence to the bundle.


Authors' conclusions

This scoping review has identified 21 studies on care bundle use in critically ill patients in ICU with COVID19, ARDS, viral influenza or pneumonia and severe respiratory failure. The data for patients with COVID19 specifically are limited, derived mainly from observational quality improvement or clinical experiential accounts. Research is required, urgently, to further assess care bundle use and optimal components of these bundles in this patient cohort. The care bundles described were also varied, with guidance on ventilator settings described in 10 care bundles, while chest Xray was part mentioned in one care bundle in one study only. None of the studies identified in this scoping review measured users' experience of adapting care bundles. Optimising care bundle implementation requires that the components of the care bundle are collectively and consistently applied. Data on challenges, barriers and facilitators to implementation are needed. A formal synthesis of the outcome data presented in this review and a critical appraisal of the evidence is required by a subsequent effectiveness review. This subsequent review should further explore effect estimates across the included studies.

Date added
Created by
Sarah Stones
Published by
Current Awareness Service for Health