We thank Strik et al. for their comments [1] and their interest in our manuscript [2]. The authors acknowledged the publication and added two more recommendations nr. 11 and 12 and shared one observation. The first recommendation includes the facilitation of “mobile phones for taking pictures and/or making audio recordings and film footage of loved ones in the intensive care unit (ICU)”, the second recommendation includes “online visiting and making contact” via apps for video conferencing. Finally, they are questioning the implementation feasibility in real-life critical care, requiring specialized staff, and observed that all recommendations support the “Empowerment of Families” and contribute to the ABCDEF bundle for family-centered care.
We appreciate the recommendations 11 and 12. Especially in times of visitor regulations due to isolation requirements, it is essential to offer alternatives for communication to patients and families including children. During the coronavirus disease 2019 (COVID-19) pandemic, virtual visits have been introduced on many ICUs, and a lot of clinicians and families became used to virtual visits [3]. Most patients appreciated the virtual visits, and staff valued this as quality-increasing compromise due to isolation regulations. Video visits with critical care patients is also useful in case families cannot be present due to long distances, own illness, or other circumstances; and even those type of visits might prevent patients from delirium [4]. In the extended version of our visiting recommendations, we recommend virtual visits as second-line option, if real visits are not possible [5].
But further aspects regarding virtual visits should be considered. First, not every patient wants to be seen by the whole family and friends, and does not always agree to virtual visits. Second, virtual visits increase the risk for sharing pictures or videos on social media, and we clinicians have a special responsibility for patient’s virtual dignity and integrity. Third, the permission to take photos might require special legal consent. Forth, the quality of real-life and virtual visits differs meaningfully. Hence, seeing and hearing each other in a video should always be a second-line or additional option in comparison to meet the patient physically—independent if the visitor is a child or an adult. Hence, in line with Strik et al., we recommend a living concept of family-centred care in all ICUs. Consequently, this concept includes a multiprofessional team approach to meet patients’ and relatives’ needs, including psychosocial professionals. Clinicians should (a) support parents’ competencies for performing (virtual) visits with their children; (b) offer verbal, written, and visual information related to the children’s cognitive and emotional development; and (c) help parents and other clinicians to communicate these children-specific information.
Virtual visits/photos can be a good way to bridge the time when a patient cannot be visited in real. However, it must be an exception. We were very pleased with the suggestions of our colleagues and will certainly follow-up on the discussions.
Acknowledgements
Authors of ICU Kids Study Group: Alexander Brinkmann (Hospital County Heidenheim), Svenja Dehner (Hospital St. Georg Leipzig), Rolf Dubb (Akademie der Kreiskliniken Reutlingen), Simon Finkeldei (KinderKrisenintervention der AETAS Kinderstiftung München), Birga Gatzweiler (LMU Klinikum Kinderpalliativzentrum München), Carsten Hermes, (Bonn), Christian Heyd (University Medicine Mainz), Magdalena Hoffmann (Medical University of Graz), Marie-Madlen Jeitziner (Inselspital Bern), Arnold Kaltwasser, (Akademie der Kreiskliniken Reutlingen), Tita Kern (KinderKrisenIntervention der AETAS Kinderstiftung München), Kathrin Knochel (Technical University Munich), Lars Krüger (University Hospital of the Ruhr University Bochum), Heiner Melching (German Society Palliative Medicine Berlin), Guido Michels (St.-Antonius-Hospital Eschweiler), Tilmann Müller-Wolff (Munich University of Applied Sciences), Sabrina Pelz (University and Rehabilitation Hospitals Ulm), Julian Rudolph (Hospital Landeskrankenhaus Feldkirch), Denise Schindele (Regionale Hospitals Holding Ludwigsburg), Anna-Henrikje Seidlein (University Medicine Greifswald), Arne Simon (University Hospital Saarland Homburg/Saar), and Marina Ufelmann (Technical University Munich).
Author contributions
All authors equally contributed and approved all versions of the manuscript.
Funding
Open Access funding enabled and organized by Projekt DEAL. This work was funded by German Society for Intensive and Critical Care Medicine and Emergency Medicine with grant number 001.
Declarations
Conflicts of interest
The authors declare that there are no funding sources and no conflicts of interest.
Footnotes
The members of the ICU study group are listed in acknowledgements.
This comment refers to the article available online at 10.1007/s00134-022-06974-w
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Maria Brauchle, Email: maria.brauchle@lkhf.at.
Teresa Deffner, Email: Teresa.Deffner@med.uni-jena.de.
Peter Nydahl, Email: Peter.Nydahl@uksh.de.
on behalf of the ICU Study Group:
Alexander Brinkmann, Svenja Dehner, Rolf Dubb, Simon Finkeldei, Birga Gatzweiler, Carsten Hermes, Christian Heyd, Magdalena Hoffmann, Marie-Madlen Jeitziner, Arnold Kaltwasser, Tita Kern, Kathrin Knochel, Lars Krüger, Heiner Melching, Guido Michels, Tilmann Müller-Wolff, Sabrina Pelz, Julian Rudolph, Denise Schindele, Anna-Henrikje Seidlein, Arne Simon, and Marina Ufelmann
References
- 1.Strik J, Tijssen K, Salamah H, de la Haye N, Schieveld J. On childrens visits, mobile phone and family empowerment in paediatric intensive care medicine. Intensive Care Med. 2023 doi: 10.1007/s00134-023-07070-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Brauchle M, Deffner T, Nydahl P. Ten recommendations for child-friendly visiting policies in critical care. Intensive Care Med. 2023;49:341–344. doi: 10.1007/s00134-022-06974-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Rose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, Rafferty AM, Ramsay P, Saha S, Xyrichis A, Meyer J. Communication and virtual visiting for families of patients in intensive care during the COVID-19 pandemic: A UK National Survey. Ann Am Thorac Soc. 2021;18:1685–1692. doi: 10.1513/AnnalsATS.202012-1500OC. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Pun BT, Badenes R, Heras La Calle G, Orun OM, Chen W, Raman R, Simpson BK, Wilson-Linville S, HinojalOlmedillo B, Vallejo de la Cueva A, van der Jagt M, Navarro Casado R, Leal Sanz P, Orhun G, Ferrer Gómez C, Núñez Vázquez K, Piñeiro Otero P, Taccone FS, GallegoCurto E, Caricato A, Woien H, Lacave G, O'Neal HR, Jr, Peterson SJ, Brummel NE, Girard TD, Ely EW, Pandharipande PP. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med. 2021;9:239–250. doi: 10.1016/S2213-2600(20)30552-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Brauchle M, Deffner M, Banaschak S, Brinkmann A, Brüning T, Dehner S, Dubb R, Filzhoefer D, Finkeldei S, Gatzweiler B, Gerlach A, Hermes C, Heyd C, Hoffmann M, Jeitziner MM, Johnen T, Kaltwasser A, Kern T, Knochel K, Krüger L, Melching M, Michels G, Tilmann Müller-Wolff T, Pelz S, Plener P, Pönicke C, Schäfer A, Rudolph J, Schindele D, Seidlein AH, Simon A, Ufelmann M, Nydahl P (2022) Empfehlungen “Kinder als Angehörige und Besuchende auf Intensivstationen, pädiatrischen Intensivstationen, IMC-Stationen und in Notaufnahmen”. https://www.divi.de/empfehlungen/publikationen/intensiv-und-notfallpflege. Accessed 16 Nov 2022