Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults

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• 作者：Louise Rose ; BN ; MN ; PhD^a ; ^b ; Lisa Burry ; PharmD^c ; ^d ; Ranjeeta Mallick ; PhD^e ; ^f ; Elena Luk ; BScN^b ; Deborah Cook ; MD^g ; ^h ; ⁱ ; Dean Fergusson ; PhD^e ; ^f ; Peter Dodek ; MD ; MHSc^j ; ^k ; Karen Burns ; MD^l ; ^m ; John Granton ; MDⁿ ; ^o ; ^p ; ^q ; ^r ; Niall Ferguson ; MD^s ; ^t ; John W. Devlin ; PharmD^u ; Marilyn Steinberg ; RN^v ; Sean Keenan ; MD^w ; ^x ; Stephen Reynolds ; MD^w ; ^x ; Maged Tanios ; MD^y ; Robert A. Fowler ; MDCM ; MS Epi^t ; ^z ; ^a ; Michael Jacka ; MD^aa ; Kendiss Olafson ; MD^ab ; Yoanna Skrobik ; MD^ac ; Sangeeta Mehta ; MD^d ; ^ad ; ^{Geeta.mehta@utoronto.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Physical restraint ; Chemical restraint ; Sedation protocol ; Daily sedation interruption ; Intensive care
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：31
• 期：1
• 页码：31-35
• 全文大小：227 K

文摘

The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint.

Methods

This was a post hoc secondary analysis using Cox proportional hazards modeling adjusted for center- and time-varying covariates to evaluate predictors of restraint use.

Results

A total of 328 (76%) of 430 patients were restrained for a median of 4 days. Restrained patients received higher daily doses of benzodiazepines (105 vs 41 mg midazolam equivalent, P < .0001) and opioids (1524 vs 919 μg fentanyl equivalents, P < .0001), more days of infusions (benzodiazepines 6 vs 4, P < .0001; opioids 7 vs 5, P = .02), and more daily benzodiazepine boluses (0.2 vs 0.1, P < .0001). More restrained patients received haloperidol (23% vs 12%, P = .02) and atypical antipsychotics (17% vs 4%, P = .003). More restrained patients experienced unintentional device removal (26% vs 3%, P < .001) and required reintubation (8% vs 1%, P = .01). In the multivariable analysis, alcohol use was associated with decreased risk of restraint (hazard ratio, 0.22; 95% confidence interval, 0.08-0.58).

Conclusions

Physical restraint was common in mechanically ventilated adults managed with a sedation protocol. Restrained patients received more opioids and benzodiazepines. Except for alcohol use, patient characteristics and treatment factors did not predict restraint use.