Predictors of physical restraint use in Canadian intensive care units
Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use. We conducted a secondary analysis of a prospective observational study of analgos...
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| Veröffentlicht in: | Critical care (London, England) England), 2014-03, Vol.18 (2), p.R46-R46, Article R46 |
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| creator | Luk, Elena Sneyers, Barbara Rose, Louise Perreault, Marc M Williamson, David R Mehta, Sangeeta Cook, Deborah J Lapinsky, Stephanie C Burry, Lisa |
| description | Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.
We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.
PR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS |
| doi_str_mv | 10.1186/cc13789 |
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We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.
PR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.
PR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>DOI: 10.1186/cc13789</identifier><identifier>PMID: 24661688</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aged ; Analysis ; Antipsychotic drugs ; Canada - epidemiology ; Care and treatment ; Dementia ; Development and progression ; Dosage and administration ; Drug therapy ; Female ; Forecasting ; Hospital patients ; Humans ; Intensive Care Units - standards ; Intensive Care Units - trends ; Male ; Middle Aged ; Patient outcomes ; Prospective Studies ; Restraint, Physical - standards ; Restraint, Physical - utilization</subject><ispartof>Critical care (London, England), 2014-03, Vol.18 (2), p.R46-R46, Article R46</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>Copyright © 2014 Luk et al.; licensee BioMed Central Ltd. 2014 Luk et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c502t-ee73409b32dbd220c300a71098dba1513fc919c82290c9f6f2aaebbe5b8a285a3</citedby><cites>FETCH-LOGICAL-c502t-ee73409b32dbd220c300a71098dba1513fc919c82290c9f6f2aaebbe5b8a285a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075126/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075126/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24661688$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luk, Elena</creatorcontrib><creatorcontrib>Sneyers, Barbara</creatorcontrib><creatorcontrib>Rose, Louise</creatorcontrib><creatorcontrib>Perreault, Marc M</creatorcontrib><creatorcontrib>Williamson, David R</creatorcontrib><creatorcontrib>Mehta, Sangeeta</creatorcontrib><creatorcontrib>Cook, Deborah J</creatorcontrib><creatorcontrib>Lapinsky, Stephanie C</creatorcontrib><creatorcontrib>Burry, Lisa</creatorcontrib><title>Predictors of physical restraint use in Canadian intensive care units</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.
We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.
PR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.
PR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.</description><subject>Adult</subject><subject>Aged</subject><subject>Analysis</subject><subject>Antipsychotic drugs</subject><subject>Canada - epidemiology</subject><subject>Care and treatment</subject><subject>Dementia</subject><subject>Development and progression</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Forecasting</subject><subject>Hospital patients</subject><subject>Humans</subject><subject>Intensive Care Units - standards</subject><subject>Intensive Care Units - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient outcomes</subject><subject>Prospective Studies</subject><subject>Restraint, Physical - standards</subject><subject>Restraint, Physical - utilization</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkd9LHDEQx4O0qLXF_0AW-mBfVvNjk01eCsehtnDQPljoW5jNzmpkL7kmu4L_vTnuFIUyDzPMfObLDF9CThm9YEyrS-eYaLU5IMesUapW1Pz9UGqhmlpLIY_Ip5wfKGWtVuKQHPECMaX1Mbn6nbD3boopV3GoNvdP2TsYq4R5SuDDVM0ZKx-qJQToPYRSTxiyf8TKQcJqDn7Kn8nHAcaMX_b5hPy5vrpd_qhXv25-Lher2knKpxqxFQ01neB913NOnaAUWkaN7jtgkonBGWac5txQZwY1cADsOpSdBq4liBPyfae7mbs19g5DOXK0m-TXkJ5sBG_fT4K_t3fx0Ta0lYyrIvBtL5Div7n8aNc-OxxHCBjnbJlsFGeNELygX3foHYxofRhiUXRb3C5kQ5USyphCXfyHKtHj2rsYcPCl_27hfLfgUsw54fB6PaN266Xde1nIs7fPvnIv5oln76mZOg</recordid><startdate>20140324</startdate><enddate>20140324</enddate><creator>Luk, Elena</creator><creator>Sneyers, Barbara</creator><creator>Rose, Louise</creator><creator>Perreault, Marc M</creator><creator>Williamson, David R</creator><creator>Mehta, Sangeeta</creator><creator>Cook, Deborah J</creator><creator>Lapinsky, Stephanie C</creator><creator>Burry, Lisa</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140324</creationdate><title>Predictors of physical restraint use in Canadian intensive care units</title><author>Luk, Elena ; Sneyers, Barbara ; Rose, Louise ; Perreault, Marc M ; Williamson, David R ; Mehta, Sangeeta ; Cook, Deborah J ; Lapinsky, Stephanie C ; Burry, Lisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c502t-ee73409b32dbd220c300a71098dba1513fc919c82290c9f6f2aaebbe5b8a285a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analysis</topic><topic>Antipsychotic drugs</topic><topic>Canada - epidemiology</topic><topic>Care and treatment</topic><topic>Dementia</topic><topic>Development and progression</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Forecasting</topic><topic>Hospital patients</topic><topic>Humans</topic><topic>Intensive Care Units - standards</topic><topic>Intensive Care Units - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient outcomes</topic><topic>Prospective Studies</topic><topic>Restraint, Physical - standards</topic><topic>Restraint, Physical - utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luk, Elena</creatorcontrib><creatorcontrib>Sneyers, Barbara</creatorcontrib><creatorcontrib>Rose, Louise</creatorcontrib><creatorcontrib>Perreault, Marc M</creatorcontrib><creatorcontrib>Williamson, David R</creatorcontrib><creatorcontrib>Mehta, Sangeeta</creatorcontrib><creatorcontrib>Cook, Deborah J</creatorcontrib><creatorcontrib>Lapinsky, Stephanie C</creatorcontrib><creatorcontrib>Burry, Lisa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luk, Elena</au><au>Sneyers, Barbara</au><au>Rose, Louise</au><au>Perreault, Marc M</au><au>Williamson, David R</au><au>Mehta, Sangeeta</au><au>Cook, Deborah J</au><au>Lapinsky, Stephanie C</au><au>Burry, Lisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of physical restraint use in Canadian intensive care units</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2014-03-24</date><risdate>2014</risdate><volume>18</volume><issue>2</issue><spage>R46</spage><epage>R46</epage><pages>R46-R46</pages><artnum>R46</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><abstract>Physical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.
We conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.
PR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.
PR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24661688</pmid><doi>10.1186/cc13789</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Analysis Antipsychotic drugs Canada - epidemiology Care and treatment Dementia Development and progression Dosage and administration Drug therapy Female Forecasting Hospital patients Humans Intensive Care Units - standards Intensive Care Units - trends Male Middle Aged Patient outcomes Prospective Studies Restraint, Physical - standards Restraint, Physical - utilization |
| title | Predictors of physical restraint use in Canadian intensive care units |
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