To compare the safety and effects of unrestricted visiting policies (UVPs) and restricted visiting policies (RVPs) in intensive care units (ICUs) with respect to outcomes related to delirium, infection, and mortality. MEDLINE, Cochrane Library, Embase, Web of Science, CINAHL, CBMdisc, CNKI, Wanfang, and VIP database records generated from their inception to 22 January 2022 were searched. Randomized controlled trials and quasi-experimental studies were included. The main outcomes investigated were delirium, ICU-acquired infection, ICU mortality, and length of ICU stay. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Random‑effects and fixed-effects meta‑analyses were conducted to obtain pooled estimates, due to heterogeneity. Meta-analyses were performed using RevMan 5.3 software. The results were analyzed using odds ratios (ORs), 95% confidence intervals (CIs), and standardized mean differences (SMDs). Eleven studies including a total of 3741 patients that compared UVPs and RVPs in ICUs were included in the analyses. Random effects modeling indicated that UVPs were associated with a reduced incidence of delirium (OR = 0.4, 95% CI 0.25–0.63, I2 = 71%, p = 0.0005). Fixed-effects modeling indicated that UVPs did not increase the incidences of ICU-acquired infections, including ventilator-associated pneumonia (OR = 0.96, 95% CI 0.71–1.30, I2 = 0%, p = 0.49), catheter-associated urinary tract infection (OR 0.97, 95% CI 0.52–1.80, I2 = 0%, p = 0.55), and catheter-related blood stream infection (OR = 1.15, 95% CI 0.72–1.84, I2 = 0%, p = 0.66), or ICU mortality (OR = 1.03, 95% CI 0.83–1.28, I2 = 49%, p = 0.12). Forest plotting indicated that UVPs could reduce the lengths of ICU stays (SMD = − 0.97, 95% CI − 1.61 to 0.32, p = 0.003). The current meta-analysis indicates that adopting a UVP may significantly reduce the incidence of delirium in ICU patients, without increasing the risks of ICU-acquired infection or mortality. Further large-scale, multicenter studies are needed to confirm these indications.

中文翻译：

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危重患者无限制探视政策的有效性和安全性：一项荟萃分析

比较重症监护病房 (ICU) 中无限制就诊政策 (UVP) 和限制就诊政策 (RVP) 在谵妄、感染和死亡率相关结果方面的安全性和效果。检索了 MEDLINE、Cochrane 图书馆、Embase、Web of Science、CINAHL、CBMdisc、CNKI、万方和 VIP 数据库从创建到 2022 年 1 月 22 日的记录。包括随机对照试验和准实验研究。调查的主要结果是谵妄、ICU获得性感染、ICU死亡率和ICU住院时间。两名审查员独立筛选研究、提取数据并评估偏倚风险。由于异质性，进行了随机效应和固定效应荟萃分析以获得汇总估计值。使用 RevMan 5.3 软件进行荟萃分析。使用优势比 (OR)、95% 置信区间 (CI) 和标准化平均差 (SMD) 分析结果。分析中纳入了 11 项研究，共 3741 名患者，比较了 ICU 中的 UVP 和 RVP。随机效应模型表明 UVP 与谵妄发生率降低相关（OR = 0.4, 95% CI 0.25–0.63, I2 = 71%, p = 0.0005）。固定效应模型表明 UVP 不会增加 ICU 获得性感染的发生率，包括呼吸机相关性肺炎（OR = 0.96, 95% CI 0.71–1.30, I2 = 0%, p = 0.49）、导管相关性尿路感染感染（OR 0.97, 95% CI 0.52–1.80, I2 = 0%, p = 0.55）和导管相关血流感染（OR = 1.15, 95% CI 0.72–1.84, I2 = 0%, p = 0.66） , 或 ICU 死亡率 (OR = 1.03, 95% CI 0.83–1.28, I2 = 49%, p = 0.12)。森林图表明 UVP 可以减少 ICU 停留时间（SMD = - 0.97, 95% CI - 1.61 to 0.32, p = 0.003）。目前的荟萃分析表明，采用 UVP 可显着降低 ICU 患者谵妄的发生率，而不会增加 ICU 获得性感染或死亡率的风险。需要进一步的大规模、多中心研究来证实这些适应症。