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

被引：71
|
作者：
Rose, Louise [1 ,2 ]
Burry, Lisa [3 ,4 ]
Mallick, Ranjeeta [5 ,6 ]
Luk, Elena [2 ]
Cook, Deborah [7 ,8 ,9 ]
Fergusson, Dean [5 ,6 ]
Dodek, Peter [10 ,11 ,12 ]
Burns, Karen [13 ,14 ,15 ]
Granton, John [16 ,17 ,18 ,19 ,20 ]
Ferguson, Niall [21 ,22 ]
Devlin, John W. [23 ]
Steinberg, Marilyn [24 ]
Keenan, Sean [25 ,26 ]
Reynolds, Stephen [26 ]
Tanios, Maged [27 ]
Fowler, Robert A. [1 ,28 ]
Jacka, Michael [29 ]
Olafson, Kendiss [30 ]
Skrobik, Yoanna [31 ]
Mehta, Sangeeta [32 ,33 ]
机构：
[1] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
[2] Univ Toronto, Lawrence S Bloomberg Fac Nursing, Toronto, ON M5T 1P8, Canada
[3] Mt Sinai Hosp, Dept Pharm & Med, Toronto, ON M5G 1X5, Canada
[4] Univ Toronto, Toronto, ON, Canada
[5] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON K1Y 4E9, Canada
[6] Univ Ottawa, Fac Med, Ottawa, ON, Canada
[7] St Josephs Healthcare, Hamilton, ON L8N 4A6, Canada
[8] McMaster Univ, Dept Med, Hamilton, ON, Canada
[9] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
[10] St Pauls Hosp, Div Crit Care Med, Vancouver, BC V6Z 1Y6, Canada
[11] St Pauls Hosp, Ctr Hlth Evaluat & Outcome Sci, Vancouver, BC V6Z 1Y6, Canada
[12] Univ British Columbia, Vancouver, BC V6Z 1Y6, Canada
[13] St Michaels Hosp, Dept Crit Care, Toronto, ON M5B 1W8, Canada
[14] Interdepartmental Div Crit Care Med, Toronto, ON, Canada
[15] Li Ka Shing Inst, Toronto, ON, Canada
[16] Univ Hlth Network, Div Respirol, Dept Med, Toronto, ON M5G 2C4, Canada
[17] Gen Res Inst, Toronto, ON M5G 2C4, Canada
[18] Univ Toronto, Inst Hlth Policy Management & Evaluat, Interdepartmental Div Crit Care Med, Toronto, ON, Canada
[19] Univ Toronto, Dept Med, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[20] Univ Toronto, Inst Hlth Policy Management & Evaluat, Dept Physiol, Toronto, ON, Canada
[21] Univ Hlth Network, Crit Care & Pulm Med, Toronto, ON M5G 2C4, Canada
[22] Univ Toronto, Interdepartmental Div Crit Care Med, Toronto, ON, Canada
[23] Northeastern Univ, Sch Pharm, Boston, MA 02115 USA
[24] Mt Sinai Hosp, Toronto, ON M5G 1X5, Canada
[25] Royal Columbia Hosp, Div Crit Care, Dept Crit Care, New Westminster, BC V3L 3W7, Canada
[26] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada
[27] Long Beach Mem Med Ctr, Dept Med, Long Beach, CA 90806 USA
[28] Sunnybrook Hlth Sci Ctr, Dept Med, Toronto, ON M4N 3M5, Canada
[29] Univ Alberta Hosp, Dept Anesthesiol, Edmonton, AB T6G 2B7, Canada
[30] Univ Manitoba, Dept Med, Sect Crit Care, Winnipeg, MB R3T 2N2, Canada
[31] McGill Univ, Dept Med, Montreal, PQ H3G 2M1, Canada
[32] Mt Sinai Hosp, Dept Med, Toronto, ON M5G 1X5, Canada
[33] Mt Sinai Hosp, Interdepartmental Div Crit Care Med, Toronto, ON M5G 1X5, Canada
来源：
JOURNAL OF CRITICAL CARE | 2016年 / 31卷 / 01期
基金：
加拿大健康研究院;
关键词：
Physical restraint; Chemical restraint; Sedation protocol; Daily sedation interruption; Intensive care; INTENSIVE-CARE PATIENTS; UNPLANNED EXTUBATION; SEDATION; DELIRIUM; SCALE; UNITS;
D O I：
10.1016/j.jcrc.2015.09.011
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Purpose: 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 919 mu g 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. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码：31 / 35
页数：5
相关论文
共 50 条
  • [1] Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults
    Mehta, Sangeeta
    Cook, Deborah
    Devlin, John W.
    Skrobik, Yoanna
    Meade, Maureen
    Fergusson, Dean
    Herridge, Margaret
    Steinberg, Marilyn
    Granton, John
    Ferguson, Niall
    Tanios, Maged
    Dodek, Peter
    Fowler, Robert
    Burns, Karen
    Jacka, Michael
    Olafson, Kendiss
    Mallick, Ranieeta
    Reynolds, Steven
    Keenan, Sean
    Burry, Lisa
    CRITICAL CARE MEDICINE, 2015, 43 (03) : 557 - 566
  • [2] Psychotropic Drug Use Before And During Physical Restraint For Mechanically Ventilated Critically Ill Adults
    L Burry
    M Guenette
    T Farquharson
    A Cheung
    S Mehta
    M Traille
    I Mantas
    L Rose
    Intensive Care Medicine Experimental, 3 (Suppl 1)
  • [3] Physical restraint in mechanically ventilated adults: A complex early diagnosis by protocols?
    Forgiarini Junior, Luiz Alberto
    Esquinas, Antonio M.
    JOURNAL OF CRITICAL CARE, 2016, 35 : 215 - 215
  • [4] VARIATION IN PHYSICAL RESTRAINT USE FOR MECHANICALLY VENTILATED PATIENTS ACROSS ICUS
    Happ, M.
    Seaman, J. B.
    Houze, M. P.
    Sereika, S. M.
    Barnato, A. E.
    GERONTOLOGIST, 2013, 53 : 442 - 442
  • [5] Response to letter to editor titled "Physical restraint in mechanically ventilated adults: A complex early diagnosis by protocols?"
    Rose, Louise
    Mehta, Sangeeta
    JOURNAL OF CRITICAL CARE, 2016, 35 : 216 - 216
  • [6] Early Physical and Occupation Therapy Is Associated With Improved Outcomes in Mechanically Ventilated Us Adults: 2008-2021
    Mintz, J.
    Mustafa, M.
    Uribe, J. P.
    Puthumana, R. M.
    Mallow, C.
    Gershengorn, H. B.
    AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2024, 209
  • [7] Physical restraint in mechanically ventilated ICU patients: a survey of French practice
    De Jonghe, Bernard
    Constantin, Jean-Michel
    Chanques, Gerald
    Capdevila, Xavier
    Lefrant, Jean-Yves
    Outin, Herve
    Mantz, Jean
    INTENSIVE CARE MEDICINE, 2013, 39 (01) : 31 - 37
  • [8] Physical restraint in mechanically ventilated ICU patients: a survey of French practice
    Bernard De Jonghe
    Jean-Michel Constantin
    Gerald Chanques
    Xavier Capdevila
    Jean-Yves Lefrant
    Hervé Outin
    Jean Mantz
    Intensive Care Medicine, 2013, 39 : 31 - 37
  • [9] Dyspnea in mechanically ventilated critically-ill patients: prevalence and risk factors
    Schmidt, M.
    Demoule, A.
    Polito, A.
    Porchet, R.
    Aboab, J.
    Similowski, T.
    Sharshar, T.
    AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2010, 181
  • [10] Iatrogenic pneumothorax in mechanically ventilated children: Incidence, risk factors and other outcomes
    Lucas da Silva, Paulo Sergio
    de Aguiar, Vania Euzebio
    Machado Fonseca, Marcelo Cunio
    HEART & LUNG, 2015, 44 (03): : 238 - 242
12345