Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults Academic Article uri icon

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abstract

  • PURPOSE: The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint. METHODS: This was a post hoc secondary analysis using Cox proportional hazards modeling adjusted for center- and time-varying covariates to evaluate predictors of restraint use. RESULTS: A total of 328 (76%) of 430 patients were restrained for a median of 4 days. Restrained patients received higher daily doses of benzodiazepines (105 vs 41 mg midazolam equivalent, P < .0001) and opioids (1524 vs 919 μg fentanyl equivalents, P < .0001), more days of infusions (benzodiazepines 6 vs 4, P < .0001; opioids 7 vs 5, P = .02), and more daily benzodiazepine boluses (0.2 vs 0.1, P < .0001). More restrained patients received haloperidol (23% vs 12%, P = .02) and atypical antipsychotics (17% vs 4%, P = .003). More restrained patients experienced unintentional device removal (26% vs 3%, P < .001) and required reintubation (8% vs 1%, P = .01). In the multivariable analysis, alcohol use was associated with decreased risk of restraint (hazard ratio, 0.22; 95% confidence interval, 0.08-0.58). CONCLUSIONS: Physical restraint was common in mechanically ventilated adults managed with a sedation protocol. Restrained patients received more opioids and benzodiazepines. Except for alcohol use, patient characteristics and treatment factors did not predict restraint use.

authors

  • Rose, Louise
  • Burry, Lisa
  • Mallick, Ranjeeta
  • Luk, Elena
  • Cook, Deborah
  • Fergusson, Dean
  • Dodek, Peter
  • Burns, Karen
  • Granton, John
  • Ferguson, Niall
  • Devlin, John W
  • Steinberg, Marilyn
  • Keenan, Sean
  • Reynolds, Stephen
  • Tanios, Maged
  • Fowler, Robert A
  • Jacka, Michael
  • Olafson, Kendiss
  • Skrobik, Yoanna
  • Mehta, Sangeeta

publication date

  • February 2016

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