PMID- 25338282
OWN - NLM
STAT- MEDLINE
DCOM- 20170119
LR  - 20170119
IS  - 1827-1596 (Electronic)
IS  - 0375-9393 (Linking)
VI  - 81
IP  - 10
DP  - 2015 Oct
TI  - Physical restraint in the ICU: does it prevent device removal?
PG  - 1086-95
AB  - BACKGROUND: Physical restraint is frequently used in the intensive care setting 
      but little is known regarding its clinical scenario and effectiveness in 
      preventing adverse events (AEs), defined as device removal. METHODS: We carried 
      out a prospective observational study in three Intensive Care Units on 120 adult 
      high-risk patients. The effectiveness of physical restraint was evaluated using 
      the propensity score methodology in order to obtain comparable groups. RESULTS: 
      Physical restraint was applied in 1371 of 3256 (43%) nurse shifts accounting for 
      120 patients. Substantial agitation, the nurse's judgement of insufficient 
      sedation and sedative drug reduction were positively associated with physical 
      restraint, whereas the presence of analgesics at admission, increased disease 
      gravity and the treating hospital as the most substantial variable showed a 
      negative association. Eighty-six AEs were observed in 44 patients. Quiet 
      (SAS=1-4), unrestrained patients accounted for 40 cases, and agitated (SAS>/=5) but 
      physically restrained patients for 17 cases. The presence of any type of physical 
      restraint had a protective effect against any type of AE (OR=0.28; CI 0.16-0.51). 
      The observed AEs showed a limited impact on the patients' course of illness. No 
      physical harm related to physical restraint was reported. CONCLUSION: Physical 
      restraint efficiently averts AEs. Its application is mainly driven by local 
      habits. Typically, the almost recovered, apparently calm and hence unrestrained 
      patient is at greatest risk for undesirable device removal. The 
      control/interpretation of the patient's analgo-sedation might be inappropriate.
FAU - Perren, A
AU  - Perren A
AD  - ICU, Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, 
      Bellinzona, Switzerland - andreas.perren@eoc.ch.
FAU - Corbella, D
AU  - Corbella D
FAU - Iapichino, E
AU  - Iapichino E
FAU - Di Bernardo, V
AU  - Di Bernardo V
FAU - Leonardi, A
AU  - Leonardi A
FAU - Di Nicolantonio, R
AU  - Di Nicolantonio R
FAU - Buschbeck, C
AU  - Buschbeck C
FAU - Boegli, L
AU  - Boegli L
FAU - Pagnamenta, A
AU  - Pagnamenta A
FAU - Malacrida, R
AU  - Malacrida R
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20141022
PL  - Italy
TA  - Minerva Anestesiol
JT  - Minerva anestesiologica
JID - 0375272
SB  - IM
CIN - Minerva Anestesiol. 2015 Oct;81(10):1053-5. PMID: 25501845
MH  - Aged
MH  - Critical Care/*methods
MH  - Delirium/complications/therapy
MH  - Device Removal/*adverse effects/*methods
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - Prospective Studies
MH  - Psychomotor Agitation/complications/therapy
MH  - *Restraint, Physical
EDAT- 2014/10/23 06:00
MHDA- 2017/01/20 06:00
CRDT- 2014/10/23 06:00
PHST- 2014/10/23 06:00 [entrez]
PHST- 2014/10/23 06:00 [pubmed]
PHST- 2017/01/20 06:00 [medline]
AID - R02Y9999N00A140959 [pii]
PST - ppublish
SO  - Minerva Anestesiol. 2015 Oct;81(10):1086-95. Epub 2014 Oct 22.