{"id":17501,"date":"2019-07-28T05:22:17","date_gmt":"2019-07-27T21:22:17","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17501"},"modified":"2019-08-06T11:21:21","modified_gmt":"2019-08-06T03:21:21","slug":"17501","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17501","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]: \u5f39\u6027\u8bbf\u89c6\u65f6\u95f4\u5bf9ICU\u60a3\u8005\u8c35\u5984\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation | Caring for the Critically Ill Patient<\/p>\n\n\n\n

Effect of Flexible Family Visitation on Delirium Among Patients in the Intensive Care Unit: The ICU Visits Randomized Clinical Trial<\/h1>\n\n\n\n

Regis Goulart Rosa, Maicon Falavigna, Daiana Barbosa da Silva, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;322(3):216-228. doi:10.1001\/jama.2019.8766<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

The effects of intensive care unit (ICU) visiting hours remain uncertain.<\/p>\n\n\n\n

ICU\u8bbf\u89c6\u65f6\u95f4\u7684\u5f71\u54cd\u5e76\u4e0d\u786e\u5b9a\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To determine whether a flexible family visitation policy in the ICU reduces the incidence of delirium.<\/p>\n\n\n\n

\u786e\u5b9aICU\u60a3\u8005\u5bb6\u5c5e\u5f39\u6027\u8bbf\u89c6\u653f\u7b56\u662f\u5426\u80fd\u591f\u964d\u4f4e\u8c35\u5984\u53d1\u751f\u7387<\/p>\n\n\n\n

Design, Setting and Participants<\/strong> \u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u5bf9\u8c61<\/h3>\n\n\n\n

Cluster-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.<\/p>\n\n\n\n

\u5728\u5df4\u897f36\u4e2a\u9650\u5236\u8bbf\u89c6\u65f6\u95f4\uff08\u6bcf\u5929< 4.5\u5c0f\u65f6\uff09\u7684\u6210\u4ebaICU\u8fdb\u884c\u7684\u7fa4\u7ec4\u4ea4\u53c9\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u7eb3\u5165\u60a3\u8005\u3001\u5bb6\u5c5e\u53ca\u4e34\u5e8a\u533b\u751f\u3002\u4ece2017\u5e744\u6708\u81f32018\u5e746\u6708\u5165\u9009\uff0c\u6700\u540e\u968f\u8bbf\u65e5\u671f\u4e3a2018\u5e747\u6708\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h3>\n\n\n\n

Flexible visitation (up to 12 hours per day) supported by family education (n\u2009=\u2009837 patients, 652 family members, and 435 clinicians) or usual restricted visitation (median, 1.5 hours per day; n\u2009=\u2009848 patients, 643 family members, and 391 clinicians). Nineteen ICUs started with flexible visitation, and 17 started with restricted visitation.<\/p>\n\n\n\n

\u5f39\u6027\u8bbf\u89c6\u65f6\u95f4\uff08\u6bcf\u5929\u4e0d\u8d85\u8fc712\u5c0f\u65f6\uff09\u8f85\u52a9\u4ee5\u5bb6\u5c5e\u5ba3\u6559\uff08n\u2009=\u2009837 \u540d\u60a3\u8005\uff0c652 \u540d\u5bb6\u5c5e\uff0c\u4ee5\u53ca435 \u540d\u533b\u52a1\u4eba\u5458\uff09\u6216\u5e38\u89c4\u9650\u5236\u8bbf\u89c6\u65f6\u95f4\uff08\u4e2d\u4f4d\u6570\uff0c\u6bcf\u59291.5 \u5c0f\u65f6\uff1bn\u2009=\u2009848 \u540d\u60a3\u8005\uff0c643 \u540d\u5bb6\u5c5e\u548c 391 \u540d\u533b\u52a1\u4eba\u5458\uff09\u3002 <\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

Primary 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).<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3aICU\u4f4f\u9662\u671f\u95f4\u8c35\u5984\u53d1\u751f\u7387\uff0c\u901a\u8fc7CAM-ICU\u8fdb\u884c\u8bc4\u4f30\u3002\u6b21\u8981\u9884\u540e\u6307\u6807\u5305\u62ecICU\u83b7\u5f97\u6027\u611f\u67d3\uff08\u60a3\u8005\uff09\uff1b\u91c7\u7528HADS\uff08\u8303\u56f4 0 [\u6700\u4f73] - 21 [\u6700\u5dee]\uff09\u8bc4\u4f30\u7684\u7126\u8651\u548c\u6291\u90c1\u75c7\u72b6\uff08\u5bb6\u5c5e\uff09\uff1b\u4ee5\u53caICU\u533b\u52a1\u4eba\u5458\u5026\u6020\uff08Maslch\u5026\u6020\u91cf\u8868\uff09\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Among 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<\/em>\u2009<\u2009.001). The incidence of delirium during ICU stay was not significantly different between flexible and restricted visitation (18.9% vs 20.1%; adjusted difference, \u22121.7% [95% CI, \u22126.1% to 2.7%]; P<\/em>\u2009=\u2009.44). 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, \u22120.8% [95% CI, \u22122.1% to 1.0%]; P<\/em>\u2009=\u2009.38) and staff burnout (22.0% vs 24.8%; adjusted difference, \u22123.8% [95% CI, \u22124.8% to 12.5%]; P<\/em>\u2009=\u2009.36). For family members, median anxiety (6.0 vs 7.0; adjusted difference, \u22121.6 [95% CI, \u22122.3 to \u22120.9]; P<\/em>\u2009<\u2009.001) and depression scores (4.0 vs 5.0; adjusted difference, \u22121.2 [95% CI, \u22122.0 to \u22120.4]; P<\/em>\u2009=\u2009.003) were significantly better with flexible visitation.<\/p>\n\n\n\n

\u603b\u5171 1685 \u540d\u60a3\u8005\uff0c1295 \u540d\u5bb6\u5c5e\u4ee5\u53ca 826 \u540d\u533b\u52a1\u4eba\u5458\u5165\u9009\uff0c1685 \u540d\u60a3\u8005 (100%)\uff08\u5e73\u5747\u5e74\u9f84\uff0c58.5 \u5c81\uff1b47.2% \u5973\u6027\uff09\uff0c1060 \u540d\u5bb6\u5c5e (81.8%)\uff08\u5e73\u5747\u5e74\u9f84\uff0c45.2 \u5c81\uff1b70.3% \u5973\u6027\uff09\uff0c\u4ee5\u53ca 737 \u540d\u533b\u52a1\u4eba\u5458 (89.2%)\uff08\u5e73\u5747\u5e74\u9f84\uff0c35.5 \u5c81\uff1b72.9% \u5973\u6027\uff09\u5b8c\u6210\u8bd5\u9a8c\u3002\u5f39\u6027\u8bbf\u89c6\u7ec4\u6bcf\u5929\u5e73\u5747\u8bbf\u89c6\u65f6\u95f4\u663e\u8457\u6f14\u5531\uff084.8 vs 1.4 \u5c0f\u65f6\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c3.4 \u5c0f\u65f6 [95% CI, 2.8 to 3.9]; P<\/em>\u2009<\u2009.001\uff09\u3002\u5f39\u6027\u8bbf\u89c6\u7ec4\u4e0e\u9650\u5236\u8bbf\u89c6\u7ec4\u60a3\u8005ICU\u4f4f\u9662\u671f\u95f4\u8c35\u5984\u53d1\u751f\u7387\u65e0\u663e\u8457\u5dee\u5f02\uff0818.9% vs 20.1%\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c\u22121.7% [95% CI, \u22126.1% to 2.7%]; P<\/em>\u2009=\u2009.44\uff09\u3002\u57289\u4e2a\u9884\u5148\u786e\u5b9a\u7684\u6b21\u8981\u9884\u540e\u6307\u6807\u4e2d\uff0c6\u9879\u6307\u6807\u5728\u4e24\u7ec4\u95f4\u6ca1\u6709\u663e\u8457\u5dee\u5f02\uff0c\u5305\u62ecICU\u83b7\u5f97\u6027\u611f\u67d3\uff083.7% vs 4.5%\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c\u22120.8% [95% CI, \u22122.1% to 1.0%]; P<\/em>\u2009=\u2009.38\uff09\u548c\u533b\u52a1\u4eba\u5458\u5026\u6020\uff0822.0% vs 24.8%\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c\u22123.8% [95% CI, \u22124.8% to 12.5%]; P<\/em>\u2009=\u2009.36\uff09\u3002\u5bf9\u4e8e\u5bb6\u5c5e\u800c\u8a00\uff0c\u5f39\u6027\u8bbf\u89c6\u7ec4\u7126\u8651\u4e2d\u4f4d\u8bc4\u5206\uff086.0 vs 7.0\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c\u22121.6 [95% CI, \u22122.3 to \u22120.9]; P<\/em>\u2009<\u2009.001\uff09\u53ca\u6291\u90c1\u4e2d\u4f4d\u8bc4\u5206\uff084.0 vs 5.0\uff1b\u6821\u6b63\u540e\u5dee\u5f02\uff0c\u22121.2 [95% CI, \u22122.0 to \u22120.4]; P<\/em>\u2009=\u2009.003\uff09\u663e\u8457\u4f18\u4e8e\u9650\u5236\u8bbf\u89c6\u7ec4\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
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\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

Among patients in the ICU, a flexible family visitation policy, vs standard restricted visiting hours, did not significantly reduce the incidence of delirium.<\/p>\n\n\n\n

\u5bf9\u4e8eICU\u60a3\u8005\uff0c\u4e0e\u6807\u51c6\u7684\u9650\u5236\u8bbf\u89c6\u65f6\u95f4\u76f8\u6bd4\uff0c\u5bb6\u5c5e\u5f39\u6027\u8bbf\u89c6\u653f\u7b56\u5e76\u4e0d\u663e\u8457\u51cf\u5c11\u8c35\u5984\u53d1\u751f\u7387\u3002<\/p>\n\n\n\n

Trial Registration<\/strong> \u8bd5\u9a8c\u6ce8\u518c<\/h3>\n\n\n\n

ClinicalTrials.gov Identifier:\u00a0NCT02932358<\/a><\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9]<\/h3>\n\n\n\n
  • \u6050\u6015\u9700\u8981\u9996\u5148\u4e86\u89e3\u5f15\u8d77\u8c35\u5984\u6700\u91cd\u8981\u7684\u56e0\u7d20\u662f\u4ec0\u4e48\uff08\u6216\u8bb8\u5b58\u5728\u5730\u57df\u5dee\u5f02\uff09\uff0c\u518d\u8ba8\u8bba\u5f39\u6027\u8bbf\u89c6\u653f\u7b56\u80fd\u5426\u6539\u5584\u8c35\u5984<\/li>
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    Original Investigation | Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17501"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17501"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17501\/revisions"}],"predecessor-version":[{"id":17519,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17501\/revisions\/17519"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17501"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17501"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17501"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}