一种用于预防谵妄的延长重症监护病房探视模式的有效性和安全性：一项前后对照研究。

Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study.

作者信息

Rosa Regis Goulart, Tonietto Tulio Frederico, da Silva Daiana Barbosa, Gutierres Franciele Aparecida, Ascoli Aline Maria, Madeira Laura Cordeiro, Rutzen William, Falavigna Maicon, Robinson Caroline Cabral, Salluh Jorge Ibrain, Cavalcanti Alexandre Biasi, Azevedo Luciano Cesar, Cremonese Rafael Viegas, Haack Tarissa Ribeiro, Eugênio Cláudia Severgnini, Dornelles Aline, Bessel Marina, Teles José Mario Meira, Skrobik Yoanna, Teixeira Cassiano

机构信息

1Department of Intensive Care, Hospital Moinhos de Vento, Porto Alegre, Brazil. 2Institute for Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil. 3Department of Intensive Care, Instituto Nacional do Câncer, Rio de Janeiro, Brazil. 4Research Institute, Hospital do Coração (HCor), São Paulo, Brazil. 5Institute for Education and Research, Hospital Sírio Libanês, São Paulo, Brazil. 6Department of Intensive Care, Hospital de Urgência de Goiânia, Goiânia, Brazil. 7Department of Medicine, McGill University, Montréal, Canada.

出版信息

Crit Care Med. 2017 Oct;45(10):1660-1667. doi: 10.1097/CCM.0000000000002588.

DOI:10.1097/CCM.0000000000002588

PMID:28671901

Abstract

OBJECTIVES

To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients.

DESIGN

Prospective single-center before and after study.

SETTING

Thirty-one-bed medical-surgical ICU.

PATIENTS

All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015.

INTERVENTIONS

Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d).

MEASUREMENTS AND MAIN RESULTS

Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups.

CONCLUSIONS

In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.

摘要

目的

评估与限制探视模式相比，延长探视模式对重症监护病房（ICU）患者谵妄发生情况的影响。

设计

前瞻性单中心前后对照研究。

地点

拥有31张床位的内科-外科ICU。

患者

2015年5月至2015年11月期间连续入住ICU、年龄大于或等于18岁且预期住院时间大于或等于24小时的所有患者。

干预措施

探视政策从限制探视模式（每天4.5小时）改为延长探视模式（每天12小时）。

测量指标及主要结果

共纳入286例患者（141例采用限制探视模式，145例采用延长探视模式）。主要结局是谵妄的累积发生率，采用ICU意识模糊评估法每天评估两次。预定义的次要结局包括谵妄/昏迷持续时间；任何ICU获得性感染；ICU获得性血流感染、肺炎和尿路感染；全因ICU死亡率；以及ICU住院时间。探视的中位持续时间从限制探视模式下的133分钟（四分位间距，97.7 - 162.0）增加到延长探视模式下的245分钟（四分位间距，175.0 - 272.0）（p < 0.001）。延长探视模式组有14例患者（9.6%）发生谵妄，而限制探视模式组为29例（20.5%）（调整后的相对风险为0.50；95%置信区间，0.26 - 0.95）。与限制探视模式组患者相比，延长探视模式组患者的谵妄/昏迷持续时间更短（1.5天[四分位间距，1.0 - 3.0]对3.0天[四分位间距，2.5 - 5.0]；p = 0.03），ICU住院时间也更短（3.0天[四分位间距，2.0 - 4.0]对4.0天[四分位间距，2.0 - 6.0]；p = 0.04）。两个研究组之间的ICU获得性感染率和全因ICU死亡率无显著差异。