Restrictions on Family Presence in the ICURestrictions on Family Presence in the ICU

To the Editor: The Commentary by Dr Berwick and Ms Kotagal¹ suggests that (presumably adult) intensive care units (ICUs) should allow unrestricted visiting hours for families despite perceived barriers to such change, including exacerbation of physiologic stress to the patient, interference with provision of care, and family exhaustion. The pediatric ICU (PICU) at my institution has allowed unlimited visiting hours for parents and family members for more than a decade. Parents are allowed to sleep in their child’s room on fold-out comforters. We limit the number of visitors to 2 persons at a time primarily because of room size constraints. I believe that the concerns used to support visiting hour restrictions are completely mitigated when unlimited visitation is permitted.

The calming influence of family is readily apparent to the PICU clinical staff when caring for critically ill children and adolescents. Families even participate in minor care such as bathing or oral suctioning. We routinely allow the presence of families during some procedures and routine ICU care. Because families are continuously present, they cooperate when asked to leave the PICU for more complicated procedures such as tracheal intubation or central line placement. We allow families to remain in the room even during some stressful situations such as brain death examination or cardiopulmonary resuscitation, an issue that has been addressed in the medical literature.² Our ICU complex contains sleep rooms for parents and a laundry facility so that exhaustion, while a concern, is rarely a problem.

The most significant benefit associated with unlimited visitation is the opportunity for thorough and timely communication. Families are able to ask questions, so that they better understand the impediments and, most importantly, the route to recovery. I believe that the adult critical care community must try what pediatric ICUs have been doing for years.