McGowan Samuel K, Gershengorn Hayley B, Sudler Andrew, Espejo Edie, Boscardin John, Li Lingsheng, Smith Alexander K, Ashana Deepshikha C, Raghunathan Karthik, Kim Shannen, Brender Teva, Vossler Kristen, Han Mary, Cobert Julien
UCSF, Internal Medicine, San Francisco, California, United States;
University of Miami School of Medicine, Miami, Florida, United States.
Ann Am Thorac Soc. 2025 Jun 20. doi: 10.1513/AnnalsATS.202411-1143OC.
Physical limb restraints are commonly used in intensive care units (ICUs) to protect patients and staff but are associated with increased morbidity. While many intubated patients in the US are physically restrained, predictors for restraints in non-intubated patients remain less clear.
To identify whether patient race, ethnicity, and preferred language are associated with restraint use in non-intubated patients across multiple ICUs in a large US hospital system.
We performed a retrospective cohort study using electronic health record (EHR) data across five ICUs within the University of California, San Francisco from 2013-2022. We included adults ≥18 years of age. We excluded patients who received mechanical ventilation during their ICU stay. Our primary independent variables were primary language and race. The outcome of interest was restraint use, defined as at least one restraint order placed during the patient's ICU stay. We modeled any restraint use using a multivariable logistic regression adjusted for sociodemographic and clinical covariates and explored interactions of our two primary exposures using sensitivity analyses and Wald testing.
Across 22,259 unique ICU admissions, we identified 11,676 non-ventilated patients. Of these, 2,411 (20%) received an order for physical restraints. In a multivariable regression model, compared to English language, Chinese language (All Dialects) (OR 1.57 [95% CI 1.31, 1.87]) and a language other than Chinese, English or Spanish (OR 1.60 [95% CI 1.36, 1.89]) were associated with increased use of restraints. Patients identifying as Black or African American were also more likely to be restrained at least once during the encounter (OR 1.51 [95% CI 1.27 - 1.79]) compared to Non-Hispanic White patients. Dialysis (OR 9.15 [95% CI 7.74, 10.83]), tube feeds (OR 4.65 [95% CI 3.44, 6.29]), and SOFA score (OR 1.17 [95% CI 1.15, 1.19] per 1 point increase) also independently increased odds of restraint use.
Patients preferring a language other than English or Spanish and those identifying as Black are more likely to be restrained in the ICU when not intubated. Interventions to minimize the use of unnecessary physical restraints could improve an inequity known to be associated with downstream harms.
肢体物理约束在重症监护病房（ICU）中普遍使用，用于保护患者和医护人员，但会增加发病率。在美国，许多插管患者会受到物理约束，而非插管患者使用约束的预测因素仍不太明确。
确定在美国一家大型医院系统的多个ICU中，非插管患者的种族、民族和首选语言是否与约束使用有关。
我们使用加利福尼亚大学旧金山分校五个ICU在2013年至2022年期间的电子健康记录（EHR）数据进行了一项回顾性队列研究。我们纳入了年龄≥18岁的成年人。我们排除了在ICU住院期间接受机械通气的患者。我们的主要自变量是主要语言和种族。感兴趣的结果是约束使用，定义为患者在ICU住院期间至少下达一次约束医嘱。我们使用多变量逻辑回归模型对任何约束使用情况进行建模，并对社会人口统计学和临床协变量进行调整，并使用敏感性分析和Wald检验探索我们两个主要暴露因素之间的相互作用。
在22259例独特的ICU入院患者中，我们确定了11676例未接受通气的患者。其中，2411例（20%）接受了物理约束医嘱。在多变量回归模型中，与英语相比，中文（所有方言）（比值比1.57[95%置信区间1.31，1.87]）以及除中文、英语或西班牙语以外的其他语言（比值比1.60[95%置信区间1.36，1.89]）与约束使用增加有关。与非西班牙裔白人患者相比，自认为是黑人或非裔美国人的患者在就诊期间也更有可能至少被约束一次（比值比1.51[95%置信区间1.27 - 1.79]）。透析（比值比9.15[95%置信区间7.74，10.83]）、管饲（比值比4.65[95%置信区间3.44，6.29]）和序贯器官衰竭评估（SOFA）评分（每增加1分比值比1.17[95%置信区间1.15，1.19]）也独立增加了约束使用的几率。
在ICU中，非插管且首选语言不是英语或西班牙语的患者以及自认为是黑人的患者更有可能受到约束。尽量减少不必要的肢体物理约束的干预措施可能会改善一种已知与下游危害相关的不平等现象。
