Tele-ICU and Critical Care Outcomes: A Systematic Review and Meta-Analysis of Current Evidence

Introduction: The growing demand for critical care services, alongside intensivist shortages and variable ICU staffing models, has driven the adoption of Telemedicine-Supported Intensive Care Units (Tele-ICUs). These systems leverage electronic audiovisual platforms to enable remote intensivist oversight and real-time clinical decision support. Despite their increasing use, particularly during the COVID-19 pandemic, the impact of Tele-ICUs on hard clinical endpoints remains inconsistently reported with conflicting findings. We conducted a systematic review and meta-analysis to assess the association between Tele-ICU implementation and ICU mortality, length of stay (LOS), in-hospital cardiac arrest (IHCA) survival, ICU readmissions, and adherence to ICU care bundles.


Methods: We searched PubMed, Embase, and Cochrane databases from 1950 to 2025 for studies comparing Tele-ICU with non-Tele-ICU care. Eligible designs included randomized trials, retrospective cohorts, and pre-post observational studies reporting at least one hard clinical outcome: ICU mortality, LOS, readmissions, or IHCA survival. Random-effects meta-analyses were used to calculate pooled estimates with 95% confidence intervals (CIs). Protocol adherence was evaluated qualitatively across studies


Results: Twenty-one studies (one RCT), comprising 785,432 ICU admissions, were included. Tele-ICU implementation was associated with a non-significant reduction in ICU mortality (RR: 0.81; 95% CI: 0.45–1.52) and a trend toward reduced ICU LOS (WMD: –0.90 days; 95% CI: –2.15 to +0.35). A large pre-post study reported a significant reduction in ICU readmissions (OR: 0.77; p = 0.038). Protocol adherence improved consistently, particularly in ventilator weaning, sedation management, and bundle-based care. However, Tele-ICU had no significant effect on IHCA survival to discharge (OR: 0.94; 95% CI: 0.83–1.07)


Conclusions: Tele-ICU implementation was associated with improved adherence to critical care protocols and favorable trends in ICU mortality, LOS, and readmissions, though most outcomes did not reach statistical significance. These findings support the promising role of Tele-ICU in enhancing care quality through evidence-based protocol compliance. Further randomized trials and high-quality observational studies are needed to clarify its clinical impact