Effect of a 24-h extended visiting policy on delirium in critically ill patients

Westphal, Glauco Adrieno; Moerschberger, Mayara Schirmer; Vollmann, Dailany D´Aroz; Inácio, Amanda Caroline; Machado, Miriam Cristine V; Sperotto, Geonice; Cavalcanti, Alexandre Biasi; Köenig, Álvaro

doi:10.1007/s00134-018-5153-5

Cited by 24 publications

(21 citation statements)

References 5 publications

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“…33 This finding contradicts previous before-andafter studies reporting a lower incidence of delirium with flexible visitation models. 3,4 Potential explanations were considered for the lack of effect of flexible visitation on delirium. The relatively short duration of implementation of flexible visitation may have mitigated the potential benefits of this intervention.…”

Section: Discussionmentioning

confidence: 99%

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Rosa

Falavigna²,

Silva

et al. 2019

JAMA

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126

122

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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.

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Section: Discussionmentioning

confidence: 99%

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Rosa

Falavigna²,

Silva

et al. 2019

JAMA

Self Cite

126

122

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“…Múltiples estudios han observado que los pacientes de las UCI que reciben visitas en un horario flexible tienen menos delirium, ansiedad y depresión 5,[11][12][13][14] . Puede disminuir el estrés del paciente al proveer organización sensorial a la sobreestimulación ambiental 1,3 , e incluso puede disminuir o estabilizar la presión arterial, frecuencia cardíaca y presión intracraneal 15 , además de problemas a mediano y largo plazo, como la reducción del trastorno del estrés postraumático 16 .…”

Section: Beneficios Y Limitaciones De Una Política De La Unidad De Cuidados Intensivos De Puertas Abiertasunclassified

“…Debemos creer que la disminución del Rev Hosp Jua Mex. 2020;87 (2) estrés, ansiedad, delirium y estrés postraumático 5,[11][12][13][14] puede ser una eficiente medida no farmacológica para fomentar el descanso.…”

Section: Beneficios Y Limitaciones De Una Política De La Unidad De Cuidados Intensivos De Puertas Abiertasunclassified

Unidad de Cuidados Intensivos de puertas abiertas: la familia dentro de cuidados intensivos

Gorordo-Delsol¹,

Garduño-López²,

Castañón-González³

2020

RHJM

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son una de las áreas más complejas de los hospitales. En ellas se admite a los pacientes graves con la intención de recuperar la estabilidad y la función orgánica y limitar secuelas. Con el argumento de priorizar la atención, se ha optado por restringir el acceso a los visitantes de los pacientes, lo que no siempre está justificado. La integración de los seres queridos a la atención del paciente ha demostrado disminuir la sobreestimulación sensorial, la ansiedad, la depresión, el trastorno de estrés postraumático y el síndrome post-UCI, así como propiciar mejor comunicación y, por tanto, toma de decisiones en beneficio del paciente. Abrir las puertas de la UCI es una medida cardinal en el proceso de humanización de los cuidados intensivos.

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“…A systematic multi-level team approach is necessary to overcome barriers to early mobilization [13], such as lack of staffing, lack of training, or lack of financial support. In a before-after study performed in a Brazilian hospital [14], extended visiting times reduced the incidence of delirium from 12.1 to 6.7%. Physical restraints are commonly used in some countries to avoid patients harming themselves or their environment.…”

mentioning

confidence: 97%

Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment?

Meyfroidt

Smith

2019

Intensive Care Med

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Effect of a 24-h extended visiting policy on delirium in critically ill patients

Cited by 24 publications

References 5 publications

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit

Unidad de Cuidados Intensivos de puertas abiertas: la familia dentro de cuidados intensivos

Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment?

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