Abstract
ObjectiveTo evaluate the effect of intensive care unit (ICU) visit on the incidence of delirium, delirium subtype, and anxiety level in ICU patients.MethodsTrained psychiatrists and nurses evaluated ICU patients for delirium, delirium subtypes, and anxiety. Propensity score matching (PSM) was used to retrospectively analyze the data. Then, we compared the differences in the incidence of delirium, delirium subtypes, and anxiety level before and after the ICU visit ban. Logistic regression was conducted to identify the risk factors for delirium subtypes and high anxiety levels.ResultsAfter PSM, there was no statistically significant difference in the incidence of delirium between the non-visiting and restrictive visiting groups (non-visiting 27.4% versus restrictive visiting 30.9%, p = 0.162). The proportion of hyperactive and mixed subtypes was higher in the non-visiting than in the restrictive visiting group (non-visiting 35.3 and 30.1% versus restrictive visiting 27.7 and 20.1%, p = 0.002). The anxiety level was higher in the non-visiting than in the restrictive visiting group (state-trait anxiety inventory score: non-visiting 53.46 ± 4.58 versus restrictive visiting 52.22 ± 6.50, p = 0.009). Patients who stayed in the ICU during the visit ban were more likely to have hyperactive (p = 0.005) and mixed subtype (p = 0.001) than those who did not. Moreover, patients who stayed in the ICU during the visit ban were more likely to experience high anxiety levels than those who did not (p < 0.001).ConclusionProhibition of ICU visits during COVID-19 pandemic did not affect the incidence of delirium during COVID-19 but could change the delirium subtype and raise anxiety level. Moreover, visiting prohibition was a risk factor for non-hypoactive delirium subtype and high anxiety levels. Therefore, ICU visits are important in dealing with delirium subtypes and anxiety in ICU patients.
Highlights
Delirium is a syndrome characterized by acute and fluctuating cognitive impairments, which include the clouding of consciousness, inattention, and disorientation
It is well known that delirium is associated with negative clinical outcomes, the severity and prognosis of delirium vary depending on three motoric subtypes: hyperactive, hypoactive, and mixed subtype
The current study aimed to examine the possible effect of family visits on the incidence of delirium, the subtype of delirium, and the level of anxiety in intensive care unit (ICU) patients
Summary
Delirium is a syndrome characterized by acute and fluctuating cognitive impairments, which include the clouding of consciousness, inattention, and disorientation. The prevalence of delirium is high in older hospitalized patients, mechanically ventilated patients, or critically ill patients (Ely et al, 2001a; van den Boogaard et al, 2012; Mehta et al, 2015). It is known that delirium is associated with adverse effects such as longer intensive care unit (ICU) stays, higher hospital costs, prolonged mechanical ventilation, cognitive decline after ICU discharge, and increased morbidity and mortality (Ely et al, 2001a; Ouimet et al, 2007; Pisani et al, 2009; Mehta et al, 2015; Goldberg et al, 2020). Patients with the hyperactive subtype have less severe outcomes than those with the other subtypes but might give rise to caring problems or inconvenience to caregivers (van den Boogaard et al, 2012; Krewulak et al, 2018)
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