Acevedo-Nuevo M, Martín-Arribas M C, González-Gil M T, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A
Organización Nacional de Trasplantes, Madrid, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
Subdirección General de Investigación en Terapia Celular y Medicina Regenerativa, Instituto de Salud Carlos III, Madrid, Spain.
Enferm Intensiva (Engl Ed). 2022 Oct-Dec;33(4):212-224. doi: 10.1016/j.enfie.2021.12.003. Epub 2022 Nov 8.
To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.
Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).
A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521).
Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.
描述并表征重症监护病房（CCU）中机械约束（MR）的使用情况，包括应用频率和质量，并研究其与疼痛/躁动 - 镇静/谵妄、护士与患者比例以及机构参与度之间的关系。
2016年2月至5月在17个CCU进行的多中心观察性研究。每个CCU的观察时间为96小时。主要变量包括约束的患病率、对MR建议的遵守程度、疼痛/躁动 - 镇静/谵妄监测以及机构参与度（协议和专业人员培训）。
共纳入1070例患者。约束的总体患病率为19.11%，气管插管（ETT）患者中为42.10%，无ETT或人工气道的患者中为13.92%。与非药物管理相关的建议的遵守率在0%至40%之间，与伦理 - 法律方面监测相关的建议的遵守率在0%至100%之间。约束患病率较低与非沟通患者的充分疼痛监测相关（P <.001）以及与为专业人员提供培训相关（P = 0.020）。在入住CCU的患者总体组（r = -0.431）和ETT患者亚组（r = -0.521）中，均发现MR使用质量与其患病率呈负相关。
ETT/人工气道患者尤其经常使用约束，但其他可能不符合使用情况的患者也会使用。在MC使用的非药物替代方法、伦理和法律警惕性以及机构参与度方面有很大的改进空间。使用经过验证的工具更好地解读患者行为可能有助于限制MR的使用。
