Hofsø Kristin, Coyer Fiona M
Department of Anaestesiology and Intensive Care Medicine, Rikshospitalet-Medical Centre, Sognsvannsveien 20, 0027, Oslo, Norway.
Intensive Crit Care Nurs. 2007 Dec;23(6):316-22. doi: 10.1016/j.iccn.2007.04.002. Epub 2007 May 23.
An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse-patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.
对机械通气患者进行护理的一个重要目标是尽量减少患者的不适和焦虑。这在一定程度上可通过频繁使用药物和身体约束来实现。重症监护病房中的大多数患者都会接受某种形式的镇静治疗。在过去几十年里，镇静的目标和使用方式发生了很大变化，文献表明有总体采用更浅镇静水平和每日中断镇静的趋势。相反，不同国家和各大洲对重症监护病房中机械通气患者使用身体约束的情况差异很大。关于使用身体约束的大部分文献来自综合医院病房和养老院，而非重症监护病房环境。近期文献表明在重症监护病房应尽量少用身体约束，并且已经启动了减少约束的方案。然而，很少有论文阐述患者对药物和身体约束作为一种治疗策略的体验。在这篇分两部分的综述的第一部分中，探讨了有关药物和身体约束的证据，特别关注术语定义、意外拔管、躁动、谵妄以及重症监护病房护士与患者的比例对这些问题的影响。本文作为第二部分，从机械通气患者的角度审视与药物和身体约束相关的证据。
