Louise Rose1, Lisa Burry2, Ranjeeta Mallick3, Elena Luk4, Deborah Cook5, Dean Fergusson3, Peter Dodek6, Karen Burns7, John Granton8, Niall Ferguson9, John W Devlin10, Marilyn Steinberg11, Sean Keenan12, Stephen Reynolds12, Maged Tanios13, Robert A Fowler14, Michael Jacka15, Kendiss Olafson16, Yoanna Skrobik17, Sangeeta Mehta18. 1. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, Canada, M5T 1P8. 2. Department of Pharmacy and Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5; University of Toronto, Toronto, ON, Canada. 3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada, K1Y 4E9; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 4. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, Canada, M5T 1P8. 5. St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, ON, Canada, L8N 4A6; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada. 6. Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y6; University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada, V6Z 1Y6. 7. Department of Critical Care, St Michael's Hospital, 30 Bond St, Toronto, ON, Canada, M5B 1W8; Interdepartmental Division of Critical Care Medicine and the Li Ka Shing Institute, Toronto, ON, Canada. 8. Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada, M5G 2C4; General Research Institute, 200 Elizabeth St, Toronto, ON, Canada, M5G 2C4; Interdepartmental Division of Critical Care Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Physiology, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 9. Critical Care and Pulmonary Medicine, University Health Network, 200 Elizabeth St, Toronto, ON, Canada, M5G 2C4; Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada. 10. School of Pharmacy, Northeastern University, 360 Huntington Ave, Boston, MA, United States, 02115. 11. Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5. 12. Department of Critical Care, Royal Columbia Hospital, Division of Critical Care, 330 E Columbia St, New Westminster, BC, Canada, V3L 3W7; University of British Columbia, Vancouver, BC, Canada. 13. Department of Medicine, Long Beach Memorial Medical Center, 2801 Atlantic Ave, Long Beach, CA, 90806. 14. Interdepartmental Division of Critical Care Medicine University of Toronto, Toronto, ON, Canada; Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada, M4N 3M5. 15. Department of Anesthesiology, University of Alberta Hospitals, 8440 112 St NW, Edmonton, AB, Canada, T6G 2B7. 16. Section of Critical Care, Department of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, Canada, R3T 2N2. 17. Department of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, QC H3G 2M1. 18. University of Toronto, Toronto, ON, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5. Electronic address: Geeta.mehta@utoronto.ca.
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.
RCT Entities:
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: Lisa Burry; Brian Hutton; David R Williamson; Sangeeta Mehta; Neill Kj Adhikari; Wei Cheng; E Wesley Ely; Ingrid Egerod; Dean A Fergusson; Louise Rose Journal: Cochrane Database Syst Rev Date: 2019-09-03
Authors: Wendy de Bruijn; Joost G Daams; Florian J G van Hunnik; Arend J Arends; A M Boelens; Ellen M Bosnak; Julie Meerveld; Ben Roelands; Barbara C van Munster; Bas Verwey; Martijn Figee; Sophia E de Rooij; Roel J T Mocking Journal: Front Psychiatry Date: 2020-02-28 Impact factor: 4.157
Authors: Sarah J Hochendoner; Gianluca Villa; Emily Sokol; Mitchell M Levy; Jason M Aliotta; Sarah J Timothy H Amass Journal: Crit Care Explor Date: 2020-11-05