Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
Department of Nursing, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
Intern Emerg Med. 2022 Jan;17(1):37-42. doi: 10.1007/s11739-021-02737-5. Epub 2021 Apr 14.
Physical restraint is widely used in the intensive care unit (ICU) to ensure patient safety despite its ethical implications. We performed a prospective observational study in six ICUs in Japan to determine the prevalence of and factors associated with physical restraint use in the ICU, a phenomenon that has not yet been reported on in Japan. Data were collected on 10 random days between November 2018 and February 2019. We evaluated physical restraint use in ICU patients aged ≥ 20 years during the data collection days. Among the 787 observations, the prevalence of physical restraint use was 32.9%; however, it was 41.5% in patients receiving invasive mechanical ventilation (IMV). The average age of patients was 68.5 years, and the average Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score was 19.4. Among the included patients, 52.1% received IMV, and 17.2% were diagnosed with delirium. Logistic regression analysis revealed that the independent factors [odds ratio (95% confidence interval)] associated with physical restraint use were age [1.02 (1.00-1.05)], APACHE II score [1.05 (1.01-1.09)], IMV [2.15 (1.16-4.01)], central venous catheter indwelling [2.66 (1.46-4.85)], sedative medication [2.98 (1.72-5.17)], agitation [7.83 (2.96-20.8)], and delirium [4.16 (2.37-7.29)]. Approximately one-third of the ICU patients required physical restraint in Japan. In addition, physical restraint use was influenced by disease severity, mental condition, and the medical apparatus used. Based on these findings, further investigations are imperative to develop strategies to reduce physical restraint use.
身体约束在重症监护病房（ICU）中被广泛使用，以确保患者安全，尽管这涉及到伦理问题。我们在日本的六家 ICU 进行了一项前瞻性观察研究，以确定 ICU 中身体约束的使用情况及其相关因素，这在日本尚未有报道。数据采集于 2018 年 11 月至 2019 年 2 月的 10 个随机日期间。我们评估了数据采集日 ICU 中年龄≥20 岁的患者使用身体约束的情况。在 787 次观察中，身体约束使用率为 32.9%；然而，在接受有创机械通气（IMV）的患者中，身体约束使用率为 41.5%。患者的平均年龄为 68.5 岁，平均急性生理和慢性健康评估（APACHE）II 评分为 19.4。在纳入的患者中，52.1%接受了 IMV，17.2%被诊断为谵妄。逻辑回归分析显示，与身体约束使用相关的独立因素[比值比（95%置信区间）]为年龄[1.02（1.00-1.05)]、APACHE II 评分[1.05（1.01-1.09)]、IMV[2.15（1.16-4.01)]、中心静脉导管留置[2.66（1.46-4.85)]、镇静药物[2.98（1.72-5.17)]、躁动[7.83（2.96-20.8)]和谵妄[4.16（2.37-7.29)]。在日本，大约三分之一的 ICU 患者需要身体约束。此外，身体约束的使用受到疾病严重程度、精神状态和使用的医疗设备的影响。基于这些发现，进一步的研究至关重要，以制定减少身体约束使用的策略。
