Telemedicine in adult intensive care: A systematic review of patient-relevant outcomes and methodological considerations

Given the growing challenges of healthcare, including an aging population and increasing shortages of specialized intensive care staff, this systematic review investigates the efficacy of telemedicine in intensive care compared to standard of care (SoC) or any other type or mode of telemedicine on patient-relevant outcomes for adult intensive care unit (ICU) patients. This systematic review follows Cochrane's methodological standards. Comprehensive searches for any controlled clinical studies were conducted in MEDLINE, Scopus, CINAHL, and CENTRAL (up to 18 April 2024, and an updated search for randomized controlled trials (RCTs) up to 29 September 2025). Twenty-six studies comparing telemedicine in intensive care to SoC with approximately 2,164,508 analysed patients were identified, including data from one cluster RCT (cRCT), two stepped-wedge cluster RCTs (sw-cRCTs), and 23 non-randomized studies of interventions (NRSIs). No other comparisons were identified. Due to high clinical and methodological heterogeneity among studies, no meta-analysis was conducted. For ICU mortality, one cRCT (15,230 patients) and two sw-cRCTs (5,915 patients) showed heterogeneous results: two found no evidence for a difference, while one favoured SoC (very low-certainty). One sw-cRCT (1,462 patients) reporting overall mortality at 180 days suggested no evidence for a difference between groups (very low-certainty). Data from one cRCT (15,230 patients) and one sw-cRCT (1,462 patients) on ICU length of stay (LOS) showed no evidence for a difference between groups (moderate- and very low-certainty). Quality of life from one sw-cRCT (786 patients) indicated no evidence for a difference (very low-certainty). Six NRSIs reported adjusted data on ICU mortality, two on overall mortality, and three on ICU LOS, with heterogeneous results. High risk of bias and substantial heterogeneity limited the certainty, emphasizing the need for robust, patient-centered research in clinical studies to define telemedicine's role in intensive care and optimize its implementation. Future studies should particularly ensure transparent and comprehensive reporting.