背景:重症监护病房(ICU)中患者的身体约束患病率估计为50%。许多医疗中心没有特定的身体约束协议,是否对病人进行身体约束取决于护理人员。身体约束的缺点包括受伤,激越和增加患创伤后应激障碍(PTSD)的风险。
目的:报告在800张床位的二级医疗中心的普通ICU患者中,身体束缚的患病率和死亡率。
方法:这项回顾性研究纳入了KfarSaba一家800张床位的二级医疗中心的普通ICU的647名患者,以色列,2020年1月至12月。数据包括人口统计,病史,逗留时间,需要机械通风,通风天数,28天死亡率,入院原因,通过里士满躁动和镇静量表(RASS)评分评估的躁动率,需要身体约束和抗精神病药物。
结果:在患者中,40%(647个中的256个)需要物理克制。与因败血症或急性呼吸衰竭而入院的患者相比,老年成年患者受到身体束缚的可能性更大。在研究样本中,11%(647中的71)需要抗精神病药。受约束患者的通气时间更长(5.9±8.2vs.0.36±1.4天;p<.001)和更高的28天死亡率(0.26±0.45vs.0.07±0.25,Z=6.86,p<.001)。病史没有差异,除了慢性药物滥用,这在克制组中更常见(18[6.9%]vs.11[2.8%],分别;p=.019),以及抗精神病药物的使用(24[9.3%]vs.19[4.8%],分别为;p=.034)和抗抑郁药(55[21.2%]vs.59[14.8%],分别为;p=.042)。克制组有较高的疾病严重程度评分,如血管加压药支持要求(174[67.2%]与69[17.3%],分别;p<.001)和透析需求(39[15.1%]与19[4.8%],分别;p<.001);住院抗精神病药物治疗的频率更高(60[23.2%]vs.11[2.8%],分别;p<.001);躁动事件的趋势更大,躁动评分更严重(RASS高于零[1.7±4.0vs.分别为0.04±0.27;p<.001]和最大RASS评分[0.19±1.6vs.分别为0.01±0.54;p<.001])。总的来说,高龄,通气天数和需要透析与28日死亡率增加相关.在克制小组中,高龄,在ICU入住期间长期使用利尿剂和使用透析与死亡风险增加相关.
结论:限制患者在ICU和住院期间往往有更高的发病率和死亡率,以及躁动事件的更大趋势和更严重的躁动评分,对住院抗精神病药物治疗的需求增加。这些关于患者特征的发现可用于制定治疗计划,以降低ICU中的身体约束率。
结论:因为限制ICU患者往往有更高的发病率和死亡率,应制定治疗方案,降低ICU患者身体束缚率。
背景:NCT04771793。
BACKGROUND: Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post-traumatic stress disorder (PTSD).
OBJECTIVE: To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800-bed secondary medical centre.
METHODS: This retrospective study included 647 patients admitted to a general ICU in an 800-bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28-day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti-psychotics.
RESULTS: Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti-psychotics. Patients who were restrained had longer duration of ventilation (5.9 ± 8.2 vs. 0.36 ± 1.4 days; p < .001) and higher 28-day mortality (0.26 ± 0.45 vs. 0.07 ± 0.25, Z = 6.86, p < .001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; p = .019), as well as the use of anti-psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; p = .034) and anti-depressants (55 [21.2%] vs. 59 [14.8%], respectively; p = .042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; p < .001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; p < .001); higher frequency of in-hospital anti-psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; p < .001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7 ± 4.0 vs. 0.04 ± 0.27, respectively; p < .001] and maximum RASS score [0.19 ± 1.6 vs. 0.01 ± 0.54, respectively; p < .001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28-day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk.
CONCLUSIONS: Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in-hospital anti-psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU.
CONCLUSIONS: Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU.
BACKGROUND: NCT04771793.