Hofsø Kristin, Coyer Fiona M
Departement of Anaestesiology and Intensive Care Medicine, Rikshospitalet-Medical Centre, Sognsvannsveien 20, 0027 Oslo, Norway.
Intensive Crit Care Nurs. 2007 Oct;23(5):249-55. doi: 10.1016/j.iccn.2007.04.003. Epub 2007 May 18.
Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. 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. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned extubation, agitation, delirium and the impact of nurse-patient ratios in the ICU on these issues. Part 2 of the paper examines the evidence related to chemical and physical restraints from the perspective of the mechanically ventilated patient.
在重症监护病房（ICU）中，经常使用化学和身体约束措施来控制躁动的患者，并防止其自我伤害和意外拔管。关于这些患者护理及治疗策略诸多问题的已发表研究结果仍相互矛盾且不明确。有关镇静和化学约束的文献显示出一种趋势，即采用较浅的镇静、使用镇静评估工具和镇静方案进行管理。目前尚不清楚哪种治疗方法对躁动和谵妄患者最为有效，而且关于镇静效果的证据也相互矛盾。大量关于使用身体约束的文献来自综合医院病房和疗养院，而非ICU环境。本文的目的是总结ICU环境中使用身体和化学约束的现有文献。在这篇分两部分的论文的第一部分中，探讨了关于化学和身体约束的证据，特别关注术语定义、意外拔管、躁动、谵妄以及ICU中护患比在这些问题上的影响。论文的第二部分从机械通气患者的角度审视与化学和身体约束相关的证据。
