Sato Tomoo, Ogushi Kenta, Kitatsuji Takakazu, Mitsui Kana, Kageoka Yoshihiro, Makino Kaoru, Hanamachi Hiroto, Sowa Yoshiki, Akamatsu Yukie, Kamiya Kuniyasu
Division of Acute Care Nursing, Kobe City College of Nursing, Kobe, JPN.
Department of Nursing, Kobe University Hospital, Kobe, JPN.
Cureus. 2025 Aug 11;17(8):e89771. doi: 10.7759/cureus.89771. eCollection 2025 Aug.
Introduction This study aimed to evaluate the impact of the no-visitation policy and the presence or absence of remote visitation during the policy period on delirium in intensive care unit (ICU) patients requiring mechanical ventilation and to obtain implications for critical care nursing practice. This research is important for informing ICU family visitation policies, as delirium is associated with increased mortality and prolonged ICU stay, and understanding the impact of family presence on delirium prevention has significant clinical implications. Methods This single-center retrospective observational study included patients who received mechanical ventilation for at least 48 hours between February 2019 and October 2022. Patients were divided into two groups based on before and after the implementation of the no-visitation policy due to the COVID-19 pandemic, and the incidence and duration of delirium were compared. Delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC), and logistic regression analysis was used to analyze the impact of the no-visitation policy on delirium occurrence. Results The study included 359 patients (pre-policy group: 183 patients, post-policy group: 176 patients). Patient demographics included a median age of 69 years (interquartile range: 56-78), Acute Physiology and Chronic Health Disease Classification System II (APACHE II) score of 21 (range: 16-27), and mechanical ventilation duration of eight days (range: 5-17). The incidence of delirium was 72.7% (133/183) in the pre-policy group and 65.9% (116/176) in the no-visitation policy group (p=0.164). The duration of delirium was four (range: two to seven) days in both groups (p=0.593). There was also no significant difference in delirium incidence based on whether remote visitation was provided in the no-visitation policy period (p=0.81). Conclusions The no-visitation policy was not significantly associated with the incidence or duration of delirium in ICU patients requiring long-term mechanical ventilation. We are suggesting that comprehensive non-pharmacological interventions, rather than family visitation alone, may be essential for delirium prevention in high-risk ICU populations.
引言 本研究旨在评估无探视政策以及该政策实施期间远程探视的有无对需要机械通气的重症监护病房（ICU）患者谵妄的影响，并得出对重症护理实践的启示。这项研究对于为ICU家属探视政策提供信息很重要，因为谵妄与死亡率增加和ICU住院时间延长相关，并且了解家属在场对谵妄预防的影响具有重大临床意义。方法 这项单中心回顾性观察性研究纳入了2019年2月至2022年10月期间接受机械通气至少48小时的患者。由于新冠疫情实施无探视政策前后，将患者分为两组，比较谵妄的发生率和持续时间。使用重症监护谵妄筛查检查表（ICDSC）评估谵妄，并采用逻辑回归分析来分析无探视政策对谵妄发生的影响。结果 该研究纳入了359例患者（政策实施前组：183例患者，政策实施后组：176例患者）。患者人口统计学特征包括中位年龄69岁（四分位间距：56 - 78），急性生理与慢性健康状况评分系统II（APACHE II）评分为21分（范围：16 - 27），机械通气持续时间为8天（范围：5 - 17）。政策实施前组谵妄发生率为72.7%（133/183），无探视政策组为65.9%（116/176）（p = 0.164）。两组谵妄持续时间均为4天（范围：2 - 7天）（p = 0.593）。在无探视政策期间是否提供远程探视，谵妄发生率也无显著差异（p = 0.81）。结论 无探视政策与需要长期机械通气的ICU患者谵妄的发生率或持续时间无显著关联。我们认为，对于高危ICU人群预防谵妄而言，综合的非药物干预措施而非仅家属探视可能至关重要。
