- Design
- Systematic review and meta-analysis of 13 randomised trials
- Population
- 3,861 adult ICU patients
- Primary outcome
- Delirium occurrence
- Effect
- RR 0.48 (95% CI 0.29–0.81); infections RR 1.00 (0.81–1.23)
This meta-analysis, published on 15 October, pooled 13 randomised trials with 3,861 adult ICU patients comparing open or flexible family visiting with restricted visiting.
Open visiting roughly halved the risk of delirium (RR 0.48) and shortened mechanical ventilation slightly, by about a third of a day. Hospital-acquired infection did not differ (RR 1.00), nor did ICU mortality or length of stay.
Restricted visiting is still common in Indian ICUs, often justified by infection control and workload. Family presence offers orientation, reassurance and familiar voices — the non-drug measures that prevent delirium. The infection concern was not supported by these trials.
Certainty is low: the trials were heterogeneous, unblinded and defined both visiting and delirium differently. But the intervention is close to free, and delirium carries long-term cognitive harm.
- Consider flexible family visiting as part of delirium prevention in adult ICUs.
- Brief families on how to help: orientation, glasses and hearing aids, familiar conversation.
- Keep hand hygiene and basic infection precautions for visitors.
- Screen for delirium every shift with a validated tool, whatever the visiting policy.
Why it matters
It removes the main argument against letting families stay — infection — while showing a large delirium benefit.
Don't overread it
Low-certainty evidence from unblinded trials; mortality did not change.
The statistics, in plain English
A risk ratio of 0.48 (95% CI 0.29 to 0.81) means about half the risk of delirium, and the interval excludes no effect. Low certainty means further trials could change the estimate, particularly because unblinded staff assessed delirium.
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