Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit Academic Article uri icon

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abstract

  • Importance: The effects of intensive care unit (ICU) visiting hours remain uncertain. Objective: To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium. Design, Setting and Participants: Cluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018. Interventions: Flexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation. Main Outcomes and Measures: Primary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory). Results: Among 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, -1.7% [95% CI, -6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, -0.8% [95% CI, -2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, -3.8% [95% CI, -4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, -1.6 [95% CI, -2.3 to -0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, -1.2 [95% CI, -2.0 to -0.4]; P = .003) were significantly better with flexible visitation. Conclusions and Relevance: Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium. Trial Registration: ClinicalTrials.gov Identifier: NCT02932358.

authors

  • Rosa, Regis Goulart
  • Falavigna, Maicon
  • da Silva, Daiana Barbosa
  • Sganzerla, Daniel
  • Santos, Mariana Martins Siqueira
  • Kochhann, Renata
  • de Moura, Rafaela Moraes
  • Eugênio, Cláudia Severgnini
  • Haack, Tarissa da Silva Ribeiro
  • Barbosa, Mirceli Goulart
  • Robinson, Caroline Cabral
  • Schneider, Daniel
  • de Oliveira, Débora Mariani
  • Jeffman, Rodrigo Wiltgen
  • Cavalcanti, Alexandre Biasi
  • Machado, Flávia Ribeiro
  • Azevedo, Luciano Cesar Pontes
  • Salluh, Jorge Ibrain Figueira
  • Pellegrini, José Augusto Santos
  • Moraes, Rafael Barberena
  • Foernges, Rafael Botelho
  • Torelly, Andre Peretti
  • Ayres, Lizandra de Oliveira
  • Duarte, Pericles Almeida Delfino
  • Lovato, Wilson José
  • Sampaio, Patrick Harrison Santana
  • de Oliveira Júnior, Lúcio Couto
  • Paranhos, Jorge Luiz da Rocha
  • Dantas, Alessandro da Silva
  • de Brito, Pollyanna Iracema Peixoto Gouveia Gomes
  • Paulo, Eliane Aparecida Peixoto
  • Gallindo, Marcos Antônio Cavalcanti
  • Pilau, Janaina
  • Valentim, Helen Martins
  • Meira Teles, José Mario
  • Nobre, Vandack
  • Birriel, Daniella Cunha
  • Corrêa e Castro, Livia
  • Specht, Andréia Martins
  • Medeiros, Gregory Saraiva
  • Tonietto, Tulio Frederico
  • Mesquita, Emersom Cicilini
  • da Silva, Nilton Brandão
  • Korte, Jeffrey E
  • Hammes, Luciano Serpa
  • Giannini, Alberto
  • Bozza, Fernando Augusto
  • Teixeira, Cassiano

publication date

  • July 16, 2019