预测危重症成人新发生身体约束使用的因素。

Predictors of New-Onset Physical Restraint Use in Critically Ill Adults.

机构信息

Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio.

Alai Tan is a research associate professor, The Ohio State University College of Nursing.

出版信息

Am J Crit Care. 2020 Mar 1;29(2):92-102. doi: 10.4037/ajcc2020361.

DOI:10.4037/ajcc2020361

PMID:32114609

Abstract

BACKGROUND

Physical restraints are frequently used for intensive care patients and are associated with substantial morbidity. The effects of common evidence-based critical care interventions on use of physical restraints remain unclear.

OBJECTIVE

To identify independent predictors of new-onset use of physical restraints in critically ill adults.

METHODS

Secondary analysis of a prospective cohort study involving 5 adult intensive care units in a tertiary care medical center in the United States. Use of physical restraints was determined via daily in-person assessments and medical record review. Mixed-effects logistic regression analysis was used to examine factors associated with new-onset use of physical restraints, adjusting for covariates and within-subject correlation among intensive care unit days.

RESULTS

Of 145 patients who were free of physical restraints within 48 hours of intensive care unit admission, 24 (16.6%) had restraints newly applied during their stay. In adjusted models, delirium (odds ratio [OR], 5.09; 95% CI, 1.83-14.14), endotracheal tube presence (OR, 3.47; 95% CI, 1.22-9.86), and benzodiazepine administration (OR, 3.17; 95% CI, 1.28-7.81) significantly increased the odds of next-day use of physical restraints. Tracheostomy was associated with significantly lowered odds of next-day restraint use (OR, 0.13; 95% CI, 0.02-0.73). Compared with patients with a target sedation level, patients who were in a coma (OR, 2.56; 95% CI, 0.80-8.18) or deeply sedated (OR, 2.53; 95% CI, 0.91-7.08) had higher odds of next-day use of physical restraints, and agitated patients (OR, 0.08; 95% CI, 0.00-2.07) were less likely to experience restraint use.

CONCLUSION

Several potentially modifiable risk factors are associated with next-day use of physical restraints.

摘要

背景

身体约束在重症监护患者中经常使用，并与大量发病率相关。常见循证重症监护干预措施对身体约束使用的影响仍不清楚。

目的

确定重症监护成人新发生使用身体约束的独立预测因素。

方法

对美国一家三级保健医疗中心的 5 个成人重症监护病房进行的前瞻性队列研究进行二次分析。通过每日的身体评估和病历审查来确定身体约束的使用情况。使用混合效应逻辑回归分析来检查与新发生使用身体约束相关的因素，同时调整协变量和重症监护病房天数内的个体内相关性。

结果

在重症监护病房入院后 48 小时内没有使用身体约束的 145 名患者中，有 24 名（16.6%）在住院期间新使用了约束。在调整后的模型中，谵妄（优势比[OR]，5.09；95%置信区间[CI]，1.83-14.14）、存在气管内管（OR，3.47；95% CI，1.22-9.86）和苯二氮䓬类药物的使用（OR，3.17；95% CI，1.28-7.81）显著增加了第二天使用身体约束的可能性。气管切开术与第二天约束使用的可能性显著降低相关（OR，0.13；95% CI，0.02-0.73）。与目标镇静水平的患者相比，处于昏迷状态（OR，2.56；95% CI，0.80-8.18）或深度镇静（OR，2.53；95% CI，0.91-7.08）的患者第二天使用身体约束的可能性更高，而躁动的患者（OR，0.08；95% CI，0.00-2.07）使用约束的可能性较低。