Effects of different visiting policies on ICU syndrom: a systematic review and meta-analysis

Abstract

Introduction: There are so many ICUs implement restrictive visiting polices (RVP) to reduce ICU acquired infection at home and abroad. However, the un-restrictive visiting policies (UVP) which maybe alleviates the anxiety. Some studies found that the RVP is the main cause of patients' pain, and the ICU patients who lack visitation have a more than threefold increased risk of delirium. There is no relevant guidance or consensus on the visiting of relatives of ICU patients at home and abroad, which visiting mode is more beneficial to ICU patients. Objectives/Aims: To compare the effects of UVP and RVP on ICU patients' delirium and ICU acquired infection. Methods: Randomised controlled trails (RCTs) and quasi-experiment about UVP and RVP in ICU were retrieved in CBM, CNKI, Wanfang Data, PubMed, Cochrane Library and Web of Science from their foundation to Decmber 31 2018. Data were extracted after strict evaluation of literature quality by two researchers, and meta-analysis was conducted on literatures that met the inclusion criteria. Results: A total of 18 studies was included in this study. The results showed that UVP can not only decrease the incidence of ICU patients delirium [RR = 0.19, 95% CI (0.10, 0.18), P < 0.00001), reduce the ICU patients anxiety score [RR = 1.60, 95% CI (1.67, 1.54), P = < 0.00001] and depression score [RR = 1.63, 95% CI (2.76, 0.49), P = 0.005), as well as improve the family members' satisfaction [RR=3.56, 95%CI(2.32,5.48), P=<0.00001]. Meanwhile, the UVP did not increase the incidence of ICU acquired infection [RR=0.82, 95%CI (0.53,1.36), P= 0.31], ICU mortality [RR=0.61, 95%CI (0.21,1.79), P=0.37], and length of ICU stay [RR=-0.40, 95%CI (-1.29, 0.50), P=0.39]. Conclusion: All available evidence points to the fact that the UVP may be the optimal ICU visitation policy.