Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial
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| Publication Date: | 2019 |
| Other Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Article |
| Language: | eng |
| Source: | Repositório Institucional da FIOCRUZ (ARCA) |
| DOI: | 10.1001/jama.2019.8766 |
| Download full: | https://arca.fiocruz.br/handle/icict/35499 |
Summary: | Fernando Augusto Bozza. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento. |
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Rosa, Regis GoulartFalavigna, MaiconSilva, Daiana Barbosa daSganzerla, DanielSantos, Mariana Martins SiqueiraKochhann, RenataMoura, Rafaela Moraes deEugênio, Cláudia SevergniniHaack, Tarissa da Silva RibeiroBarbosa, Mirceli GoulartRobinson, Caroline CabralSchneider, DanielOliveira, Débora Mariani deJeffman, Rodrigo WiltgenCavalcanti, Alexandre BiasiMachado, Flávia RibeiroAzevedo, Luciano Cesar PontesSalluh, Jorge Ibrain FigueiraPellegrini, José Augusto SantosMoraes, Rafael BarberenaFoernges, Rafael BotelhoTorelly, Andre PerettiAyres, Lizandra de OliveiraDuarte, Pericles Almeida DelfinoLovato, Wilson JoséSampaio, Patrick Harrison Santanade Oliveira Júnior, Lúcio CoutoParanhos, Jorge Luiz da RochaDantas, Alessandro da SilvaBrito, Pollyanna Iracema Peixoto Gouveia Gomes dePaulo, Eliane Aparecida PeixotoGallindo, Marcos Antônio CavalcantiPilau, JanainaValentim, Helen MartinsTeles, José Mario MeiraNobre, VandackBirriel, Daniella CunhaCastro, Livia Corrêa eSpecht, Andréia MartinsMedeiros, Gregory SaraivaTonietto, Tulio FredericoMesquita, Emersom CiciliniSilva, Nilton Brandão daKorte, Jeffrey eHammes, Luciano SerpaGiannini, AlbertoBozza, Fernando A.Teixeira, Cassiano2019-09-11T14:52:11Z2019-09-11T14:52:11Z2019ROSA, Regis Goulart et al. Effect of flexible family visitation on delirium among patients in the intensive care unit the ICU visits randomized clinical trial. JAMA, v. 322, n. 3, p. 216-228, 2019.0098-7484https://arca.fiocruz.br/handle/icict/3549910.1001/jama.2019.87662574-3805Fernando Augusto Bozza. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil (Rosa, D. B. da Silva, Eugênio, Haack, Medeiros, Tonietto, Teixeira); Research Projects Office, HMV, Porto Alegre, Rio Grande do Sul, Brazil (Rosa, Falavigna, D. B. da Silva, Sganzerla, Santos, Kochhann, de Moura, Eugênio, Haack, Barbosa, Robinson, Schneider, de Oliveira, Jeffman, Medeiros, Hammes); Brazilian Research in Intensive Care Network (BRICNet), São Paulo, São Paulo (Rosa, Cavalcanti, Machado, Azevedo, Salluh, Nobre, Bozza, Teixeira); HCor Research Institute, São Paulo, São Paulo, Brazil (Cavalcanti); Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil (Machado); Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil (Azevedo); Department of Critical Care, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Rio de Janeiro, Brazil (Salluh, Mesquita, Bozza); Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil (Pellegrini, Moraes); Intensive Care Unit, Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul, Brazil (Foernges); Intensive Care Unit, Hospital Santa Rita, Porto Alegre, Rio Grande do Sul, Brazil (Torelly); Intensive Care Unit, Hospital Universitário do Oeste do Paraná, Cascavel, Paraná, Brazil (Ayres, Duarte); Intensive Care Unit, Hospital do Câncer de Cascavel, Cascavel, Paraná, Brazil (Duarte); Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil (Lovato); Intensive Care Unit, Santa Casa de Misericórdia de Feira de Santana, Feira de Santana, Bahia, Brazil (Sampaio); Intensive Care Unit, Hospital Geral Clériston Andrade, Feira de Santana, Bahia, Brazil (de Oliveira Júnior); Intensive Care Unit, Santa Casa de Misericórdia de São João Del Rei, São João Del Rei, Minas Gerais, Brazil (Paranhos); Intensive Care Unit, Hospital Regional Doutor Deoclécio Marques de Lucena, Parnamirim, Rio Grande do Norte, Brazil (Dantas, de Brito); Intensive Care Unit, Fundação Hospital Adriano Jorge, Manaus, Amazonas, Brazil (Paulo); Intensive Care Unit, Hospital Agamenon Magalhães, Recife, Pernambuco, Brazil (Gallindo); Intensive Care Unit, Hospital da Cidade, Passo Fundo, Rio Grande do Sul, Brazil (Pilau); Intensive Care Unit, Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil (Valentim); Intensive Care Unit, Hospital de Urgências de Goiânia, Goiânia, Goiânia, Brazil (Meira Teles); Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil (Nobre); Intensive Care Unit, Pavilhão Pereira Filho, Porto Alegre, Rio Grande do Sul, Brazil (Birriel); Intensive Care Unit, Hospital Regional do Baixo Amazonas, Santarém, Pará, Brazil (Corrêa e Castro); Intensive Care Unit, Hospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul, Brazil (Specht); School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil (N. B. da Silva); Department of Public Health Sciences, Medical University of South Carolina, Charleston (Korte); Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini—ASST Spedali Civili, Brescia, Italy (Giannini); Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil (Bozza).Múltipla - Ver em Notas.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.engJAMA NetworkEffect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFamily visitationPatientsICUinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83104https://arca.fiocruz.br/bitstreams/07929f28-7f0f-4cc2-a58b-92cfaa7c60be/download79178e5f2a0eb066867a274556814938MD51falseAnonymousREADORIGINALve_Rosa_Regis_etal_INI_2019.pdfve_Rosa_Regis_etal_INI_2019.pdfapplication/pdf616825https://arca.fiocruz.br/bitstreams/6a0a898c-0401-4bfc-b92f-72e03cd8436d/download2aae5be305137324e272a08cc32e9270MD52trueAnonymousREADTEXTve_Rosa_Regis_etal_INI_2019.pdf.txtve_Rosa_Regis_etal_INI_2019.pdf.txtExtracted texttext/plain89951https://arca.fiocruz.br/bitstreams/aa55ab84-7945-4b3c-b0f5-9447cc7805a8/download24a2c20f1a6d329724e891d4cb7cef07MD55falseAnonymousREADTHUMBNAILve_Rosa_Regis_etal_INI_2019.pdf.jpgve_Rosa_Regis_etal_INI_2019.pdf.jpgGenerated Thumbnailimage/jpeg5651https://arca.fiocruz.br/bitstreams/2c02a0cf-61bd-40cf-b222-f9382ec06839/download504a369fa7ae462ebe7fbc744a2759d7MD56falseAnonymousREADicict/354992025-07-29 23:48:57.058open.accessoai:arca.fiocruz.br:icict/35499https://arca.fiocruz.brRepositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352025-07-30T02:48:57Repositório Institucional da FIOCRUZ (ARCA) - 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| dc.title.none.fl_str_mv |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| title |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| spellingShingle |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial Rosa, Regis Goulart Family visitation Patients ICU |
| title_short |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| title_full |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| title_fullStr |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| title_full_unstemmed |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| title_sort |
Effect of flexible family visitation on delirium among patients in the Intensive Care Unit: the ICU visits randomized clinical trial |
| author |
Rosa, Regis Goulart |
| author_facet |
Rosa, Regis Goulart Falavigna, Maicon Silva, Daiana Barbosa da Sganzerla, Daniel Santos, Mariana Martins Siqueira Kochhann, Renata Moura, Rafaela Moraes de Eugênio, Cláudia Severgnini Haack, Tarissa da Silva Ribeiro Barbosa, Mirceli Goulart Robinson, Caroline Cabral Schneider, Daniel Oliveira, Débora Mariani de 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 Brito, Pollyanna Iracema Peixoto Gouveia Gomes de Paulo, Eliane Aparecida Peixoto Gallindo, Marcos Antônio Cavalcanti Pilau, Janaina Valentim, Helen Martins Teles, José Mario Meira Nobre, Vandack Birriel, Daniella Cunha Castro, Livia Corrêa e Specht, Andréia Martins Medeiros, Gregory Saraiva Tonietto, Tulio Frederico Mesquita, Emersom Cicilini Silva, Nilton Brandão da Korte, Jeffrey e Hammes, Luciano Serpa Giannini, Alberto Bozza, Fernando A. Teixeira, Cassiano |
| author_role |
author |
| author2 |
Falavigna, Maicon Silva, Daiana Barbosa da Sganzerla, Daniel Santos, Mariana Martins Siqueira Kochhann, Renata Moura, Rafaela Moraes de Eugênio, Cláudia Severgnini Haack, Tarissa da Silva Ribeiro Barbosa, Mirceli Goulart Robinson, Caroline Cabral Schneider, Daniel Oliveira, Débora Mariani de 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 Brito, Pollyanna Iracema Peixoto Gouveia Gomes de Paulo, Eliane Aparecida Peixoto Gallindo, Marcos Antônio Cavalcanti Pilau, Janaina Valentim, Helen Martins Teles, José Mario Meira Nobre, Vandack Birriel, Daniella Cunha Castro, Livia Corrêa e Specht, Andréia Martins Medeiros, Gregory Saraiva Tonietto, Tulio Frederico Mesquita, Emersom Cicilini Silva, Nilton Brandão da Korte, Jeffrey e Hammes, Luciano Serpa Giannini, Alberto Bozza, Fernando A. Teixeira, Cassiano |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.author.fl_str_mv |
Rosa, Regis Goulart Falavigna, Maicon Silva, Daiana Barbosa da Sganzerla, Daniel Santos, Mariana Martins Siqueira Kochhann, Renata Moura, Rafaela Moraes de Eugênio, Cláudia Severgnini Haack, Tarissa da Silva Ribeiro Barbosa, Mirceli Goulart Robinson, Caroline Cabral Schneider, Daniel Oliveira, Débora Mariani de 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 Brito, Pollyanna Iracema Peixoto Gouveia Gomes de Paulo, Eliane Aparecida Peixoto Gallindo, Marcos Antônio Cavalcanti Pilau, Janaina Valentim, Helen Martins Teles, José Mario Meira Nobre, Vandack Birriel, Daniella Cunha Castro, Livia Corrêa e Specht, Andréia Martins Medeiros, Gregory Saraiva Tonietto, Tulio Frederico Mesquita, Emersom Cicilini Silva, Nilton Brandão da Korte, Jeffrey e Hammes, Luciano Serpa Giannini, Alberto Bozza, Fernando A. Teixeira, Cassiano |
| dc.subject.en.none.fl_str_mv |
Family visitation Patients ICU |
| topic |
Family visitation Patients ICU |
| description |
Fernando Augusto Bozza. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento. |
| publishDate |
2019 |
| dc.date.accessioned.fl_str_mv |
2019-09-11T14:52:11Z |
| dc.date.available.fl_str_mv |
2019-09-11T14:52:11Z |
| dc.date.issued.fl_str_mv |
2019 |
| dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
| dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
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article |
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publishedVersion |
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ROSA, Regis Goulart et al. Effect of flexible family visitation on delirium among patients in the intensive care unit the ICU visits randomized clinical trial. JAMA, v. 322, n. 3, p. 216-228, 2019. |
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https://arca.fiocruz.br/handle/icict/35499 |
| dc.identifier.issn.none.fl_str_mv |
0098-7484 |
| dc.identifier.doi.none.fl_str_mv |
10.1001/jama.2019.8766 |
| dc.identifier.eissn.none.fl_str_mv |
2574-3805 |
| identifier_str_mv |
ROSA, Regis Goulart et al. Effect of flexible family visitation on delirium among patients in the intensive care unit the ICU visits randomized clinical trial. JAMA, v. 322, n. 3, p. 216-228, 2019. 0098-7484 10.1001/jama.2019.8766 2574-3805 |
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https://arca.fiocruz.br/handle/icict/35499 |
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eng |
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eng |
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info:eu-repo/semantics/openAccess |
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openAccess |
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JAMA Network |
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JAMA Network |
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