Hadassah Hebrew University Medical Center, General Intensive Care Unit, Jerusalem, Israel.
Intensive Crit Care Nurs. 2010 Oct;26(5):241-5. doi: 10.1016/j.iccn.2010.08.003.
The use of physical restraint has been linked to delirium in ICU patients and a range of physical and psychological outcomes in non-ICU patients. However, the extent of restraint practice in ICUs is largely unknown. This study was designed to examine physical restraint practices across European ICUs. A prospective point prevalence survey was conducted in adult ICUs across European countries to examine: physical and chemical restraint use during the weekend and weekdays, reasons for physical restraint use, timing of restraint use, type of restraint used and availability of restraint policies. Thirty-four general (adult) ICUs in nine countries participated in the study providing information on 669 patients with details of physical and chemical restraint use in 566 patients. Prevalence of physical restraint use in individual units ranged from 0 to 100% of patients. Thirty-three per cent of patients were physically restrained; those that were restrained were more likely to be ventilated (χ(2)=87.56, p<0.001), sedated (χ(2)34.66, p<0.001), managed in a larger unit (χ(2)=10.741, p=.005) and managed in a unit with a lower daytime nurse:patient ratio (χ(2)=17.17, p=0.001). Larger units were more likely to use commercial wrist restraints and smaller units were more likely to have a restraint policy, although these results did not reach significance. As an initial exploration, this study provides evidence of the range of restraint practice across Units in Europe. Variation in the number of units per country limits generalization of findings. However, further examination is needed to determine whether there is a causal element to these relationships. Attention should be paid to developing evidence based guidelines to underpin restraint practices.
身体约束的使用与 ICU 患者的谵妄以及非 ICU 患者的一系列身体和心理结果有关。然而，ICU 中约束的使用程度在很大程度上是未知的。本研究旨在检查欧洲 ICU 中的身体约束实践。在欧洲各国的成人 ICU 中进行了一项前瞻性时点患病率调查，以检查：周末和工作日期间的身体和化学约束使用、身体约束使用的原因、约束使用的时间、使用的约束类型以及约束政策的可用性。来自九个国家的 34 家综合（成人）ICU 参与了该研究，提供了 9 个国家 34 家综合（成人）ICU 的信息，涉及 669 名患者，其中 566 名患者的身体和化学约束使用情况。个别单位身体约束使用率的范围为 0 至 100%的患者。33%的患者受到身体约束；被约束的患者更有可能接受通气（χ(2)=87.56，p<0.001）、镇静（χ(2)=34.66，p<0.001）、在更大的单位接受治疗（χ(2)=10.741，p=.005）以及在白天护士与患者比例较低的单位接受治疗（χ(2)=17.17，p=0.001）。较大的单位更有可能使用商业手腕约束带，较小的单位更有可能有约束政策，尽管这些结果没有达到显著性。作为初步探索，本研究提供了欧洲各单位在约束实践方面的范围的证据。每个国家的单位数量的差异限制了研究结果的推广。然而，需要进一步研究以确定这些关系是否存在因果关系。应注意制定循证指南来支持约束实践。
