Risks and benefits of animal-assisted interventions for critically ill patients admitted to intensive care units

Marco Fiore; Andrea Cortegiani; Giansaverio Friolo; Francesca Frigieri Covani; Luigi Cardia; Fausto Ferraro; Daniela Alampi

doi:10.1186/s44158-023-00100-y

Risks and benefits of animal-assisted interventions for critically ill patients admitted to intensive care units

J Anesth Analg Crit Care. 2023 May 31;3(1):15. doi: 10.1186/s44158-023-00100-y.

Authors

Marco Fiore¹, Andrea Cortegiani^{2

3}, Giansaverio Friolo⁴, Francesca Frigieri Covani⁵, Luigi Cardia⁶, Fausto Ferraro⁷, Daniela Alampi^{8

9}

Affiliations

¹ Department of Women, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy. marco.fiore@unicampania.it.
² Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
³ Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy.
⁴ Sham Italia - Relyens group, Milan, Italy.
⁵ Department of Intensive Care, Santa Maria Annunziata Hospital, Florence, Italy.
⁶ Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy.
⁷ Department of Women, Child, and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
⁸ Department of Clinical and Surgical Translational Medicine, Sapienza University, Rome, Italy.
⁹ Unit of Anesthesia, Intensive Care and Pain Medicine, Sant'Andrea Hospital, Rome, Italy.

Abstract

Background: Pets offer significant health benefits, from decreased cardiovascular risks to anxiety and post-traumatic stress improvements. Animal-assisted interventions (AAI) are not frequently practiced in the intensive care unit (ICU) for fear of health risk for critical patients because there is a hypothetical risk of zoonoses.

Objectives: This systematic review aimed to collect and summarize available evidence about AAI in the ICU. The Review questions were "Do AAI improve the clinical outcome of Critically Ill Patients admitted to ICUs?" and "Are the zoonotic infections the cause of negative prognosis?".

Methods: The following databases were searched on 5 January 2023: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and PubMed. All controlled studies (randomized controlled, quasi-experimental, and observational studies) were included. The systematic review protocol has been registered on the International Prospective Register of Systematic Review (CRD42022344539).

Results: A total of 1302 papers were retrieved, 1262 after the duplicate remotion. Of these, only 34 were assessed for eligibility and only 6 were included in the qualitative synthesis. In all the studies included the dog was the animal used for the AAI with a total of 118 cases and 128 controls. Studies have high variability, and no one has used increased survival or zoonotic risk as outcomes.

Conclusions: The evidence on the effectiveness of AAIs in ICU settings is scarce and no data are available on their safety. AAIs use in the ICU must be considered experimental and follow the related regulation until further data will be available. Given the potential positive impact on patient-centered outcomes, a research effort for high-quality studies seems to be justified.

Keywords: Animal-assisted activities; Animal-assisted interventions; Animal-assisted therapy; Critically ill patient; Intensive care; Patient-centered outcomes; Pet therapy; Systematic review.

Publication types

Review