• Antonio Paulo Nassar Junior, BesenBruno Adler Maccagnan PinheiroBAMPDivision of Emergency Medicine, School of Medicine, Universidade de São Paulo (USP), São Paulo, Brazil.Intensive Care Unit, Hospital da Luz, São Paulo, Brazil., Caroline Cabral Robinson, Maicon Falavigna, Cassiano Teixeira, and Regis Goulart Rosa.
• Department of Critical Care, A.C. Camargo Cancer Center, São Paulo, Brazil.
• Crit. Care Med. 2018 Jul 1; 46 (7): 1175-1180.

ObjectivesTo synthesize data on outcomes related to patients, family members, and ICU professionals by comparing flexible versus restrictive visiting policies in ICUs.Data SourcesMedline, Scopus, and Web of Science.Study SelectionObservational and randomized studies comparing flexible versus restrictive visiting policies in the ICU and evaluating at least one patient-, family member-, or ICU staff-related outcome.Data ExtractionDuplicate independent review and data abstraction.Data SynthesisOf 16 studies identified for inclusion, seven were meta-analyzed. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium (odds ratio, 0.39; 95% CI, 0.22-0.69; I = 0%) and lower severity of anxiety symptoms (mean difference, -2.20; 95% CI, -3.80 to -0.61; I = 71%). Flexible visiting policies were not associated with increased risk of ICU mortality (odds ratio, 0.71; 95% CI, 0.38-1.36; I = 86%), ICU-acquired infections (odds ratio, 0.98; 95% CI, 0.68-1.42; I = 11%), or longer ICU stay (mean difference, -0.26 d; 95% CI, -0.57 to 0.05; I = 54%). Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels.ConclusionsFlexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU professionals. These conclusions are based on few studies, with small samples and moderate risk of bias.

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