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Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults
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Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults
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Journal Article
Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults
2016
Overview
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.
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.
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).
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.
Publisher
Elsevier Inc,Elsevier Limited
Subject
/ Aged
/ Alcohol Drinking - epidemiology
/ Analgesics, Opioid - therapeutic use
/ Antipsychotic Agents - therapeutic use
/ Benzodiazepines - therapeutic use
/ Female
/ Haloperidol - therapeutic use
/ Humans
/ Hydromorphone - therapeutic use
/ Male
/ Respiration, Artificial - methods
/ Restraint, Physical - statistics & numerical data
