Effect Of Prolonged Family Visiting Time On Delirium Duration In Patients With AECOPD Undergoing Mechanical Ventilation

Chronic Obstructive Pulmonary Diseases(COPD)is a common respiratory disease,which has become a global public health challenge due to its high morbidity,disability and mortality.Epidemiology shows that the disease burden of COPD ranks second in China.Acute Exacerbation Chronic Obstructive Pulmonary Diseases(AECOPD)refers to an acute attack on the basis of COPD lesions,the main clinical manifestations included dyspnea,bronchitis,hypoxemia and hypercapnia.At present,mechanical ventilation is mainly used to improve the clinical symptoms,but long-term continuous mechanical ventilation is susceptible to cause delirium in patients.At present,the treatment of delirium mainly includes drug intervention and non-drug intervention.Drug interventions include analgesics,sedatives and traditional antipsychotics;non-drug interventions mainly included noise control strategies,music therapy,physical therapy,cognitive stimulation activities,family visiting,high-light therapy,etc.Family care can effectively improve the mental state of patients and promote the recovery of disease.Previous studies have reported that prolonged family visiting may improve the duration of delirium in patients.However,the effect of extended family visiting on the occurrence and duration of delirium in patients with AECOPD undergoing mechanical ventilation in the ICU has not been reported yet.Objective:To investigate the incidence and duration of delirium induced by mechanical ventilation in patients with AECOPD in ICU;to explore the effects of prolonged family visiting time on the delirium incidence,duration of delirium,duration of mechanical ventilation,length of stay in ICU,anxiety and depression of patients and their families in patients with AECOPD undergoing mechanical ventilation.Methods:This study was a randomized controlled trial.Ninety-four patients with AECOPD undergoing mechanical ventilation in the ICU ward of a third-class A hospital in Shandong Province were selected.After the approval of the ethics committee and informed consent of the patients,they were randomly divided into intervention group and control group.The control group received 0.5 hours of family visiting per day;on this basis,the intervention group extended 3 hours family visiting time every day.The main intervention included bedside conversation for 0.5h,family-assisted in bed body movement for 1.0h,family-assisted sit up beside bed for 1 hour,family-assisted sit up beside wheelchair for 0.5 h,the intervention continued until the patient transferred from ICU,During the intervention,7 patients from the control group died,and 3patients from the intervention group died.Outcome include: the incidence of delirium,duration of delirium,duration of ventilation time,length of stay in ICU,infection indicators,oxygenation index,partial pressure of carbon dioxide,anxiety and depression level of patients and their families.The assessment tools mainly include the ICU Confusion Assessment Scale(CAM-ICU),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS).Outcome measures were collected at the time of admission and transfer from ICU.Epidata3.1 was used for data entry,and SPSS24.0 was used for statistical analysis.The chi-square test,t test,Fisher’s exact test were used to compare the baseline data between groups.The Wilcoxon signed rank sum test and chi-square test were used to compare the effect of intervention between groups.P<0.05 indicated that the difference was statistically significant.Results:1.Delirium duration: The duration of delirium in the control group was4.00(1.00,5.25)days,the duration of delirium in the intervention group was 2.00(0.00,4.00)days.The duration of delirium was significantly shorter in the intervention group compared with the control group(P<0.05).2.The incidence of delirium: 36 cases of delirium occurred in the control group,with an incidence rate of 85.70%;26 cases of delirium occurred in the intervention group,with an incidence rate of 61.90%.The result of comparison between groups showed that the incidence of delirium in the intervention group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).3.Mechanical ventilation time: The mechanical ventilation time of the control group was 79.00(52.00,141.85)hours,and the mechanical ventilation time of the intervention group was 55.00(40.00,92.00)hours.The result of the comparison between the groups showed that the mechanical ventilation time of the intervention group was significantly shorter than that of the control group(P<0.05).4.Length of stay in ICU: The length of stay in ICU of the control group was 7.00(4.00,8.25)days,and the length of stay in ICU of the intervention group was 4.50(3.00,6.25)days.The result of comparison between groups showed that the length of stay in ICU of the intervention group was significantly shorter than that of the control group(P<0.05).5.ICU acquired infection: The comparison between two groups of variables including white blood cells,procalcitonin,and C-reactive protein showed that the differences between two groups were not statistically significant(P>0.05),which shows that prolonged family visiting time did not increase the nosocomial infection.6.Anxiety and depression of patients and their families: Compared with the control group,the SAS and SDS scores of patients in the intervention group were significantly reduced after intervention(P<0.05);and the SAS and SDS scores of family members in the intervention group were also significantly lower than those in the control group.(P<0.05).7.Oxygenation index and partial pressure of carbon dioxide: At the end of the intervention,the oxygenation index of the control group was 188.75(134.00,249.12),and the oxygenation index of the intervention group was 222.50(197.78,301.25).The oxygenation index in the intervention group was significantly higher than that in the control group(P<0.05).Conclusion:1.Prolonged family visiting time can reduce the incidence of delirium and shorten the duration of delirium of patients with AECOPD mechanical ventilation in ICU.2.Prolonged family visiting time can shorten the mechanical ventilation time and the ICU hospitalization time of patients with AECOPD mechanical ventilation in ICU.3.Prolonged family visiting time can reduce the level of anxiety and depression of patients with AECOPD mechanical ventilation in ICU and their family members.4.Prolonged family visiting time did not increase the probability of ICU acquired infection,indicating that this intervention is safe and effective,which is worthy of promotion.