Wang Yun, Liu Ying, Tian Ya-Li, Gu Su-Lian
Department of Geriatric ICU, Jiangsu Province Hospital, Nanjing, China.
Department of ICU, Jiangsu Province Hospital, Nanjing, China.
Emerg Med Int. 2023 Apr 17;2023:6618366. doi: 10.1155/2023/6618366. eCollection 2023.
Despite its ethical implications, physical restraint (PR) is widely used in the intensive care unit (ICU) to guarantee the safety of patients. This study investigated the frequency and risk factors of PR use for patients in the ICU to establish a predictive nomogram.
Clinical parameters of patients admitted to the ICU of Jiangsu Province Hospital from January 2021 to July 2021 were retrospectively collected. Independent risk factors of PR were analyzed by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram. Model performance was validated using the concordance-index (C-index) and calibration curves.
The rate of PR use was 46.32% (233/503 patients). Age ( = 0.036, odds ratio [OR]: 1.037, 95% confidence interval [CI]: 1.022-1.052, < 0.001), consciousness disorder ( = 0.770, OR: 2.159, 95% CI: 1.216-3.832, =0.009), coma ( = -1.666, OR: 0.189, 95% CI: 0.101-0.353, < 0.001), passive activity ( = 1.014, OR: 2.756, 95% CI: 1.644-4.618, < 0.001), delirium ( = 0.993, OR: 2.699, 95% CI: 1.097-6.642, =0.031), -3 < Richmond Agitation Sedation Scale (RASS) score <2 ( = 0.698, OR: 2.009, 95% CI: 1.026-3.935, =0.042), RASS score ≥2 ( = 1.253, OR: 3.499, 95% CI: 1.126-10.875, =0.030), and mechanical ventilation ( = 1.696, OR: 5.455, 95% CI: 2.804-10.611, < 0.001) were identified as independent risk factors for PR in the ICU ( < 0.05) and included in the nomogram. The C-index was 0.830, and the calibration curve indicated good discriminatory ability and accuracy (mean absolute error: 0.026).
The prediction nomogram model of PR in ICU was established based on age, mobility, delirium, consciousness, RASS score, and mechanical ventilation. It showed good discrimination and accuracy. This nomogram may predict the probability of PR use in the ICU and guide nurses in developing precise interventions to reduce the rate of PR.
尽管存在伦理问题，但身体约束（PR）在重症监护病房（ICU）中仍被广泛使用，以确保患者安全。本研究调查了ICU患者使用PR的频率和危险因素，以建立预测列线图。
回顾性收集2021年1月至2021年7月在江苏省人民医院ICU住院患者的临床参数。通过单因素和多因素逻辑回归分析PR的独立危险因素。使用R软件建立列线图。使用一致性指数（C指数）和校准曲线验证模型性能。
PR使用率为46.32%（233/503例患者）。年龄（=0.036，比值比[OR]：1.037，95%置信区间[CI]：1.022-1.052，<0.001）、意识障碍（=0.770，OR：2.159，95%CI：1.216-3.832，=0.009）、昏迷（= -1.666，OR：0.189，95%CI：0.101-0.353，<0.001）、被动活动（=1.014，OR：2.756，95%CI：1.644-4.618，<0.001）、谵妄（=0.993，OR：2.699，95%CI：1.097-6.642，=0.031）、-3＜里士满躁动镇静量表（RASS）评分＜2（=0.698，OR：2.009，95%CI：1.026-3.935，=0.042）、RASS评分≥2（=1.253，OR：3.499，95%CI：1.126-10.875，=0.030）及机械通气（=1.696，OR：5.455，95%CI：2.804-10.611，<0.001）被确定为ICU中PR的独立危险因素（<0.05）并纳入列线图。C指数为0.830，校准曲线显示出良好的区分能力和准确性（平均绝对误差：0.026）。
基于年龄、活动能力、谵妄、意识、RASS评分和机械通气建立了ICU中PR的预测列线图模型。它显示出良好的区分度和准确性。该列线图可预测ICU中使用PR的概率，并指导护士制定精准干预措施以降低PR使用率。
