title: Predictors of physical restraint use in Canadian intensive care units.
abstract: BACKGROUND
  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 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.
  
  
  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 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.
  
  
  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.
authors.forename: Elena
authors.initials: E
authors.lastname: Luk
authors.forename: Barbara
authors.initials: B
authors.lastname: Sneyers
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.forename: Marc M
authors.initials: MM
authors.lastname: Perreault
authors.forename: David R
authors.initials: DR
authors.lastname: Williamson
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Lapinsky
authors.forename: Lisa
authors.initials: L
authors.lastname: Burry
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012149:Restraint, Physical / Q000592:standards / Q000706:statistics & numerical data*