1. Crit Care. 2014 Mar 24;18(2):R46. [Epub ahead of print]

Predictors of physical restraint use in Canadian intensive care units.

Luk E, Sneyers B, Rose L, Perreault MM, Williamson DR, Mehta S, Cook DJ, Lapinsky
SC, Burry L.

INTRODUCTION: 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.
METHODS: We conducted a secondary analysis of a prospective observational study
of analgo-sedation, 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.
RESULTS: 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) 1.00-1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01-1.06),
antipsychotic drugs (OR 3.09, 95% CI 1.74-5.48), agitation (Sedation-Agitation
Scale (SAS) >4) (OR 3.73, 95% CI 1.50-9.29), and sedation administration method
(continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74-5.48). Hospital
characteristics associated with PR indicated patients were less likely to be
restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI
0.17-0.61). Mainly treatment characteristics were associated with more days of
PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07,
95% CI 1.01-1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48-8.10),
antipsychotic drugs (IRR 15.67, 95% CI 6.62-37.12), SAS <3 (IRR 2.62, 95% CI
1.08-6.35), and any adverse event including accidental device removal (IRR 8.27, 
95% CI 2.07-33.08). 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.
CONCLUSIONS: 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.

PMID: 24661688  [PubMed - as supplied by publisher]