• Regis Goulart Rosa, Maicon Falavigna, Daiana Barbosa da Silva, Daniel Sganzerla, Mariana Martins Siqueira Santos, Renata Kochhann, Rafaela Moraes de Moura, Cláudia Severgnini Eugênio, Tarissa da Silva Ribeiro Haack, Mirceli Goulart Barbosa, Caroline Cabral Robinson, Daniel Schneider, Débora Mariani de Oliveira, Rodrigo Wiltgen Jeffman, Alexandre Biasi Cavalcanti, Flávia Ribeiro Machado, Azevedo Luciano Cesar Pontes LCP Brazilian Research in Intensive Care Network (BRICNet), São Paulo, São Paulo. , Salluh Jorge Ibrain Figueira JIF Brazilian Research in Intensive Care Network (BRICNet), São Paulo, São Paulo. , Pellegrini José Augusto Santos JAS Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil., Rafael Barberena Moraes, Rafael Botelho Foernges, Andre Peretti Torelly, Lizandra de Oliveira Ayres, Duarte Pericles Almeida Delfino PAD Intensive Care Unit, Hospital Universitário do Oeste do Paraná, Cascavel, Paraná, Brazil. , Wilson José Lovato, Patrick Harrison Santana Sampaio, Lúcio Couto de Oliveira Júnior, Jorge Luiz da Rocha Paranhos, Alessandro da Silva Dantas, Pollyanna Iracema Peixoto Gouveia Gomes de Brito, Eliane Aparecida Peixoto Paulo, Marcos Antônio Cavalcanti Gallindo, Janaina Pilau, Helen Martins Valentim, Meira Teles José Mario JM Intensive Care Unit, Hospital de Urgências de Goiânia, Goiânia, Goiânia, Brazil., Vandack Nobre, Daniella Cunha Birriel, Livia Corrêa E Castro, Andréia Martins Specht, Gregory Saraiva Medeiros, Tulio Frederico Tonietto, Emersom Cicilini Mesquita, da Silva Nilton Brandão NB School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil., Jeffrey E Korte, Luciano Serpa Hammes, Alberto Giannini, Fernando Augusto Bozza, Cassiano Teixeira, and ICU Visits Study Group Investigators and the Brazilian Research in Intensive Care Network (BRICNet).
• Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Rio Grande do Sul, Brazil.
• JAMA. 2019 Jul 16; 322 (3): 216-228.

ImportanceThe effects of intensive care unit (ICU) visiting hours remain uncertain.ObjectiveTo determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium.Design, Setting And ParticipantsCluster-crossover randomized clinical trial involving patients, family members, and clinicians from 36 adult ICUs with restricted visiting hours (<4.5 hours per day) in Brazil. Participants were recruited from April 2017 to June 2018, with follow-up until July 2018.InterventionsFlexible visitation (up to 12 hours per day) supported by family education (n = 837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n = 848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation.Main Outcomes And MeasuresPrimary outcome was incidence of delirium during ICU stay, assessed using the CAM-ICU. Secondary outcomes included ICU-acquired infections for patients; symptoms of anxiety and depression assessed using the HADS (range, 0 [best] to 21 [worst]) for family members; and burnout for ICU staff (Maslach Burnout Inventory).ResultsAmong 1685 patients, 1295 family members, and 826 clinicians enrolled, 1685 patients (100%) (mean age, 58.5 years; 47.2% women), 1060 family members (81.8%) (mean age, 45.2 years; 70.3% women), and 737 clinicians (89.2%) (mean age, 35.5 years; 72.9% women) completed the trial. The mean daily duration of visits was significantly higher with flexible visitation (4.8 vs 1.4 hours; adjusted difference, 3.4 hours [95% CI, 2.8 to 3.9]; P < .001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, -1.7% [95% CI, -6.1% to 2.7%]; P = .44). Among 9 prespecified secondary outcomes, 6 did not differ significantly between flexible and restricted visitation, including ICU-acquired infections (3.7% vs 4.5%; adjusted difference, -0.8% [95% CI, -2.1% to 1.0%]; P = .38) and staff burnout (22.0% vs 24.8%; adjusted difference, -3.8% [95% CI, -4.8% to 12.5%]; P = .36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, -1.6 [95% CI, -2.3 to -0.9]; P < .001) and depression scores (4.0 vs 5.0; adjusted difference, -1.2 [95% CI, -2.0 to -0.4]; P = .003) were significantly better with flexible visitation.Conclusions And RelevanceAmong patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium.Trial RegistrationClinicalTrials.gov Identifier: NCT02932358.

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