Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit - Results from a pilot, randomized trial
Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit - Results from a pilot, randomized trial
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DOI：
10.1161/circulationaha.105.572537
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发表时间：
2006-02-21
期刊：
影响因子：
37.8
通讯作者：
Marchionni, N
中科院分区：
文献类型：
--
作者：
Fumagalli, S;Boncinelli, L;Marchionni, N
背景-观察性研究表明，大多数重症监护病房(ICU)的患者和来访者更喜欢开放式探视政策，但没有随机试验比较非限制性(UVP)和限制性(RVP)探视政策的安全性和健康结果。这项先导性随机试验的目的是比较UVP(单一访客的频率和持续时间由患者选择)和RVP(单一访客，每天两次，每次30分钟)与RVP相关的并发症。方法和结果：在6个床位的ICU中，两种访视策略的两个月顺序随机交替进行2年，226例患者入选(RVP/UVP，n=115/111)。系统地评估了环境微生物污染、败血症和心血管并发症、情绪状态和应激激素反应。在随机安排的UVP期间入院的患者得到了更频繁的(平均每天+/-0.2vs2.0+/-0.0sem)和更长的就诊时间(2.6hd+/-0.2vs1.0+/-0.0h/d)(P<；0.001)。尽管UVP期间环境微生物污染显著增加，但两个时期的败血症并发症相似。RVP期间发生心血管并发症的风险是RVP期间的2倍(优势比2.0；95%CI，1.1至3.5；P=0.03)，且与死亡率(5.2%对1.8%；P=0.28)无显著相关。结论：尽管环境微生物污染较大，但放宽ICU探视时间并不会增加败血症并发症，相反，它可能通过减少焦虑和更有利的激素谱来减少心血管并发症。
Background - Observational studies suggest that open visiting policies are preferred by most patients and visitors in intensive care units (ICUs), but no randomized trial has compared the safety and health outcomes of unrestrictive (UVP) and restrictive (RVP) visiting policies. The aim of this pilot, randomized trial was to compare the complications associated with UVP (single visitor with frequency and duration chosen by patient) and RVP ( single visitor for 30 minutes twice a day).Methods and Results - Two-month sequences of the 2 visiting policies were randomly alternated for 2 years in a 6-bed ICU, with 226 patients enrolled (RVP/UVP, n = 115/111). Environmental microbial contamination, septic and cardiovascular complications, emotional profile, and stress hormones response were systematically assessed. Patients admitted during the randomly scheduled periods of UVP received more frequent (3.2 +/- 0.2 versus 2.0 +/- 0.0 visits per day, mean +/- SEM) and longer (2.6 +/- 0.2 versus 1.0 +/- 0.0 h/d) visits (P < 0.001 for both comparisons). Despite significantly higher environmental microbial contamination during the UVP periods, septic complications were similar in the 2 periods. The risk of cardiocirculatory complications was 2-fold (odds ratio 2.0; 95% CI, 1.1 to 3.5; P = 0.03) in the RVP periods, which were also associated with a nonsignificantly higher mortality rate (5.2% versus 1.8%; P = 0.28). The UVP was associated with a greater reduction in anxiety score and a significantly lower increase in thyroid stimulating hormone from admission to discharge.Conclusions - Despite greater environmental microbial contamination, liberalizing visiting hours in ICUs does not increase septic complications, whereas it might reduce cardiovascular complications, possibly through reduced anxiety and more favorable hormonal profile.