Rose Louise, Burry Lisa, Mallick Ranjeeta, Luk Elena, Cook Deborah, Fergusson Dean, Dodek Peter, Burns Karen, Granton John, Ferguson Niall, Devlin John W, Steinberg Marilyn, Keenan Sean, Reynolds Stephen, Tanios Maged, Fowler Robert A, Jacka Michael, Olafson Kendiss, Skrobik Yoanna, Mehta Sangeeta
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, Canada, M5T 1P8.
Department of Pharmacy and Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5; University of Toronto, Toronto, ON, Canada.
J Crit Care. 2016 Feb;31(1):31-5. doi: 10.1016/j.jcrc.2015.09.011. Epub 2015 Sep 25.
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.
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.
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).
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.
本研究旨在描述参与一项程序化镇静随机试验的约束与非约束患者的特征及结局，该试验将程序化镇静与程序化镇静加每日镇静中断进行比较，并确定与身体约束相关的患者和治疗因素。
这是一项事后二次分析，使用Cox比例风险模型，并对中心和随时间变化的协变量进行调整，以评估约束使用的预测因素。
430例患者中共有328例（76%）被约束，中位时间为4天。被约束患者每日接受更高剂量的苯二氮䓬类药物（咪达唑仑等效剂量为105 vs 41 mg，P <.0001）和阿片类药物（芬太尼等效剂量为1524 vs 919 μg，P <.0001），输液天数更多（苯二氮䓬类药物为6 vs 4天，P <.0001；阿片类药物为7 vs 5天，P =.02），每日苯二氮䓬类药物推注次数更多（0.2 vs 0.1次，P <.0001）。更多被约束患者接受了氟哌啶醇（23% vs 12%，P =.02）和非典型抗精神病药物（17% vs 4%，P =.003）。更多被约束患者经历了意外设备移除（26% vs 3%，P <.001）并需要重新插管（8% vs 1%，P =.01）。在多变量分析中，饮酒与约束风险降低相关（风险比，0.22；95%置信区间，0.08 - 0.58）。
在采用镇静方案管理的机械通气成人患者中，身体约束很常见。被约束患者接受了更多的阿片类药物和苯二氮䓬类药物。除饮酒外，患者特征和治疗因素并不能预测约束的使用。
