Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults.
OBJECTIVE
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.
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.
Louise
L
Rose
Department of Pharmacy and Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5; University of Toronto, Toronto, ON, Canada.
Lisa
L
Burry
Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada, K1Y 4E9; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Ranjeeta
R
Mallick
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, Canada, M5T 1P8.
Elena
E
Luk
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.
Deborah
D
Cook
Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada, K1Y 4E9; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Dean
D
Fergusson
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.
Peter
P
Dodek
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.
Karen
K
Burns
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.
John
J
Granton
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.
Niall
N
Ferguson
School of Pharmacy, Northeastern University, 360 Huntington Ave, Boston, MA, United States, 02115.
John W
JW
Devlin
Mount Sinai Hospital, 600 University Ave, Toronto, ON, Canada, M5G 1X5.
Marilyn
M
Steinberg
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.
Sean
S
Keenan
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.
Stephen
S
Reynolds
Department of Medicine, Long Beach Memorial Medical Center, 2801 Atlantic Ave, Long Beach, CA, 90806.
Maged
M
Tanios
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.
Robert A
RA
Fowler
Department of Anesthesiology, University of Alberta Hospitals, 8440 112 St NW, Edmonton, AB, Canada, T6G 2B7.
Michael
M
Jacka
Section of Critical Care, Department of Medicine, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, Canada, R3T 2N2.
Kendiss
K
Olafson
Department of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, QC H3G 2M1.
Yoanna
Y
Skrobik
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.
Sangeeta
S
Mehta
D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D002985:Clinical Protocols; D020878:Device Removal; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007362:Intensive Care Units; D008140:Lorazepam / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000379:methods*; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D012307:Risk Factors; D012122:Ventilators, Mechanical
D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D009020:Morphine; D006220:Haloperidol; D008140:Lorazepam; D004091:Hydromorphone; D008874:Midazolam; D005283:Fentanyl
Chemical restraint; Daily sedation interruption; Intensive care; Physical restraint; Sedation protocol