Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia.
Department of Anaesthetics, Redcliffe Hospital, Redcliffe, Queensland, Australia.
Ann Am Thorac Soc. 2021 Apr;18(4):689-697. doi: 10.1513/AnnalsATS.202006-738OC.
Physical restraints are used liberally in some intensive care units (ICUs) to prevent patient harm from device removal or falls. Although the intention of restraint use is patient safety, their application may inadvertently cause physical or psychological harm. Physical restraints may contribute to post-traumatic stress disorder (PTSD), but there is a paucity of supportive data. To investigate the association between physical restraint use and PTSD symptoms in ICU survivors. Secondary objectives were to examine the cognitive and physical outcomes associated with physical restraint use and to assess interventions that may be effective in reducing restraint use. A systematic review of English language studies in PubMed, Medline, Embase, CINAHL, and CENTRAL between January 1, 1990, to February 8, 2020 was performed. Observational or randomized studies that reported on restraint use and associated outcomes, or interventions to reduce restraint use, in critically ill adult patients were identified. Two independent reviewers completed the review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We identified 794 articles, of which 37 met inclusion criteria and were included. Thirty of these studies related to patient outcomes including PTSD, delirium, mechanical ventilation hours, and physical injury. Seven related to interventions to reduce physical restraint use. The quality of studies was not high; only four of the included studies were assessed to have a low risk of bias. Three studies found a significant relationship between restraint use and PTSD, but their results could not be pooled for analysis. Pooled data indicated a significant association between physical restraint use and delirium (odds ratio [OR], 11.54; 95% confidence interval [CI], 6.66-20.01; < 0.001) and duration of mechanical ventilation (mean difference in days, 3.35; 95% CI, 1.95-4.75; < 0.001). We also found that interventions, such as nursing education, may effectively reduce restraint use by approximately 50% (OR, 0.48; 95% CI, 0.32-0.73; < 0.001). The impact that a reduction in restraint use may have on associated outcomes was not examined. Physical restraint use may be associated with PTSD in ICU survivors and is associated with delirium and longer duration of mechanical ventilation. Nurse education is likely effective in reducing rates of physical restraint among ICU patients.
在一些重症监护病房（ICUs）中，广泛使用身体约束来防止患者因移除设备或跌倒而受伤。尽管使用约束的目的是为了患者安全，但它们的应用可能会无意中造成身体或心理伤害。身体约束可能会导致创伤后应激障碍（PTSD），但支持这一观点的数据很少。本研究旨在调查 ICU 幸存者中身体约束使用与 PTSD 症状之间的关联。次要目标是检查与身体约束使用相关的认知和身体结果，并评估可能有效减少约束使用的干预措施。我们对 1990 年 1 月 1 日至 2020 年 2 月 8 日期间在 PubMed、Medline、Embase、CINAHL 和 CENTRAL 中发表的英语研究进行了系统评价。确定了报告 ICU 成年患者中约束使用及其相关结果或减少约束使用干预措施的观察性或随机研究。两名独立审查员按照系统评价和荟萃分析报告的首选项目指南完成了审查。我们共确定了 794 篇文章，其中 37 篇符合纳入标准并被纳入。其中 30 项研究与 PTSD、谵妄、机械通气时间和身体损伤等患者结局相关。另外 7 项研究涉及减少身体约束使用的干预措施。研究质量不高；只有 4 项纳入研究被评估为低偏倚风险。三项研究发现约束使用与 PTSD 之间存在显著关系，但无法对其结果进行汇总分析。汇总数据表明，身体约束使用与谵妄（比值比 [OR]，11.54；95%置信区间 [CI]，6.66-20.01；<0.001）和机械通气时间（平均差异天数，3.35；95% CI，1.95-4.75；<0.001）之间存在显著关联。我们还发现，护理教育等干预措施可能有效减少约 50%的约束使用（OR，0.48；95% CI，0.32-0.73；<0.001）。约束使用减少对相关结局的影响尚未进行评估。身体约束的使用可能与 ICU 幸存者的 PTSD 有关，并与谵妄和机械通气时间延长有关。对 ICU 患者进行护理教育可能会有效降低身体约束的使用。
