The Impact of Family Visits on Delirium in Patients Admitted to the Intensive Care Unit: A Systematic Review

Delirium is an acute disturbance in attention and awareness that affects patients admitted to the ICUs, and its incidence is particularly high in mechanically ventilated patients. This systematic review aimed to evaluate the impact of liberalizing family visiting hours on reducing the incidence of delirium in adult ICU patients. A systematic search was conducted across PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. This review included randomized controlled trials (RCTs) and observational studies comparing liberal or frequent family visiting strategies versus restrictive visiting policies in adult ICU patients. The primary outcome was the incidence of delirium in the ICU, which was assessed by the confusion assessment method (CAM) or Intensive Care Delirium Screening Checklist (ICDSC). It was prospectively registered with PROSPERO. The pooled analysis of four studies (512 delirium events among 2291 patients in the flexible group vs. 382 events among 1793 patients in the restricted group) found no statistically significant difference in delirium incidence between both groups (risk ratio (RR): 0.82; 95% confidence interval (CI): 0.60-1.12; p=0.21), with substantial heterogeneity (I²=77%). This systematic review and meta-analysis found no significant reduction in the incidence of ICU delirium with liberal family visiting hours. The limitations of the review include methodological heterogeneity, high risk of bias, and variability in visitation protocols and delirium assessment methods among included studies. We recommend well-designed studies in the future to assess the true impact of flexible visiting polices in the ICU.