Department of Anesthesiology, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nurs Crit Care. 2024 Sep;29(5):1132-1141. doi: 10.1111/nicc.13130. Epub 2024 Jul 14.
Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post-traumatic stress disorder (PTSD).
To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800-bed secondary medical centre.
This retrospective study included 647 patients admitted to a general ICU in an 800-bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28-day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti-psychotics.
Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti-psychotics. Patients who were restrained had longer duration of ventilation (5.9 ± 8.2 vs. 0.36 ± 1.4 days; p < .001) and higher 28-day mortality (0.26 ± 0.45 vs. 0.07 ± 0.25, Z = 6.86, p < .001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; p = .019), as well as the use of anti-psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; p = .034) and anti-depressants (55 [21.2%] vs. 59 [14.8%], respectively; p = .042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; p < .001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; p < .001); higher frequency of in-hospital anti-psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; p < .001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7 ± 4.0 vs. 0.04 ± 0.27, respectively; p < .001] and maximum RASS score [0.19 ± 1.6 vs. 0.01 ± 0.54, respectively; p < .001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28-day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk.
Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in-hospital anti-psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU.
Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU.
NCT04771793.
重症监护病房（ICU）中对患者进行身体约束的比例估计为 50%。许多医疗中心没有专门的身体约束协议，是否对患者进行身体约束的决定取决于护理人员。身体约束的缺点包括受伤、激越加重和创伤后应激障碍（PTSD）风险增加。
报告在一个拥有 800 张床位的二级医疗中心的普通 ICU 患者中，身体约束的流行率和发病率及死亡率方面的结果。
这是一项回顾性研究，纳入了 2020 年 1 月至 12 月期间在以色列卡法萨巴的一个拥有 800 张床位的二级医疗中心的普通 ICU 中收治的 647 名患者。数据包括人口统计学资料、病史、住院时间、需要机械通气、通气天数、28 天死亡率、入院原因、Richmond 躁动镇静评分（RASS）评估的躁动率、需要身体约束和需要使用抗精神病药物的情况。
在患者中，40%（256/647）需要身体约束。老年患者和因败血症或急性呼吸衰竭入院的患者更有可能接受身体约束。在研究样本中，11%（71/647）需要使用抗精神病药物。接受约束的患者通气时间更长（5.9±8.2 与 0.36±1.4 天；p<0.001），28 天死亡率更高（0.26±0.45 与 0.07±0.25，Z=6.86，p<0.001）。两组在病史方面没有差异，除了慢性药物滥用，在约束组中更为常见（18[6.9%]与 11[2.8%]；p=0.019），以及抗精神病药物（24[9.3%]与 19[4.8%]；p=0.034）和抗抑郁药（55[21.2%]与 59[14.8%]；p=0.042）的使用。约束组的疾病严重程度评分更高，需要血管加压支持的比例更高（174[67.2%]与 69[17.3%]；p<0.001）和需要透析的比例更高（39[15.1%]与 19[4.8%]；p<0.001）；住院期间抗精神病治疗的频率更高（60[23.2%]与 11[2.8%]；p<0.001）；躁动事件的发生率更高，躁动评分更严重（RASS 评分高于 0 的发作次数[1.7±4.0 与 0.04±0.27，p<0.001]和最大 RASS 评分[0.19±1.6 与 0.01±0.54，p<0.001]）。总的来说，年龄较大、通气天数和需要透析与 28 天死亡率增加相关。在约束组中，年龄较大、慢性使用利尿剂和 ICU 入院期间使用透析与死亡率增加风险相关。
在 ICU 和住院期间，接受约束的患者往往发病率和死亡率更高，躁动事件的发生率更高，躁动评分更严重，需要更多的院内抗精神病治疗。这些关于患者特征的发现可能被用于制定治疗计划，以降低 ICU 中身体约束的发生率。
由于接受约束的 ICU 患者往往发病率和死亡率更高，因此应制定治疗计划以降低 ICU 中身体约束的发生率。
NCT04771793。
