Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran
Mahin Nomali, Aryan Ayati, Mohammad Yadegari, Mahdis Nomali, Mahnaz Modanloo
Citation Information :
Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022; 26 (2):192-198.
Background/aim: Patients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran.
Materials and methods: In this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses.
Results: Data from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5% of patients. Restrained patients had more severe disease [mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1)], longer length of stay [mean of 10 (5.5) vs 5.5 (4.6) days], and lower level of consciousness [mean of GCS score, 8.7 (3.5) vs 13.5 (3.3)] than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs [odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04–7.82], presence of delirium (OR, 15.13; 95% CI: 4.61–49.65), deep sedation (OR, 0.04; 95% CI: 0.00–0.45), and GCS score (OR, 0.69; 95% CI: 0.53–0.9).
Conclusion: This study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors.
Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29(7):1370–1379. DOI: 10.1097/00003246-200107000-00012.
Hine K. The use of physical restraint in critical care. Nurs Crit Care 2007;12(1):6–11. DOI: 10.1111/j.1478-5153.2006.00197.x.
Benbenbishty J, Adam S, Endacott R. Physical restraint use in intensive care units across Europe: the PRICE study. Intensive Crit Care Nurs 2010;26(5):241–245. DOI: 10.1016/j.iccn.2010.08.003.
Choi E, Song M. Physical restraint use in a Korean ICU. J Clin Nurs 2003;12(5):651–659. DOI: 10.1046/j.1365-2702.2003.00789.x.
De Jonghe B, Constantin J-M, Chanques G, Capdevila X, Lefrant J-Y, Outin H, et al. Physical restraint in mechanically ventilated ICU patients: a survey of French practice. Intensive Care Med 2013;39(1):31–37. DOI: 10.1007/s00134-012-2715-9.
Langley G, Schmollgruber S, Egan A. Restraints in intensive care units—a mixed method study. Intensive Crit Care Nurs 2011;27(2): 67–75. DOI: 10.1016/j.iccn.2010.12.001.
Martin B, Mathisen L. Use of physical restraints in adult critical care: a bicultural study. Am J Crit Care 2005;14(2):133–142. PMID: 15728955.
Moghadam MF, Khoshknab MF, Pazargadi M. Psychiatric nurses’ perceptions about physical restraint: a qualitative study. Int J Community Based Nurs Midwifery 2014;2(1):20. PMID: 25349842.
Moradimajd P, Noghabi AA, Zolfaghari M, Mehran A. Physical restraint use in intensive care units. Iran J Crit Care Nurs 2015;8(3):173–178.
Chang L-Y, Wang K-WK, Chao Y-F. Influence of physical restraint on unplanned extubation of adult intensive care patients: a case-control study. Am J Crit Care 2008;17(5):408–415. PMID: 18775996.
Jones C, Bäckman C, Capuzzo M, Flaatten H, Rylander C, Griffiths R. Precipitants of post-traumatic stress disorder following intensive care: role and need of physical restraints. Reply by authors to Dr Kapadia. Intensive Care Medicine 2007;33(12):2227. DOI: 10.1007/s00134-007-0872-z.
Van Rompaey B, Elseviers MM, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 2009;13(3):R77. DOI: 10.1186/cc7892.
Luk E, Sneyers B, Rose L, Perreault MM, Williamson DR, Mehta S, et al. Predictors of physical restraint use in Canadian intensive care units. Crit Care 2014;18(2):R46. DOI: 10.1186/cc13789.
Al-Khaled T, Zahran E, El-Soussi A. Nurses’ related factors influencing the use of physical restraint in critical care units. J Am Sci 2011;7(8): 13–22.
Minnick AF, Mion LC, Johnson ME, Catrambone C, Leipzig R. Prevalence and variation of physical restraint use in acute care settings in the US. J Nurs Scholarsh 2007;39(1):30–37. DOI: 10.1111/j.1547-5069.2007.00140.x.
Li X, Fawcett TN. Clinical decision making on the use of physical restraint in intensive care units. Int J Nurs Sci 2014;1(4):446–450. DOI: 10.1016/j.ijnss.2014.09.003.
Evans D, Wood J, Lambert L. A review of physical restraint minimization in the acute and residential care settings. J Adv Nurs 2002;40(6):616–625. DOI: 10.1046/j.1365-2648.2002.02422.x.
Happ M, Kagan S, Strumpf N, Evans L, Sullivan-Marx E. Elderly patients memories of physical restraint use in the intensive care unit (ICU). Am J Crit Care 2001;10(5):367–369. DOI: 10.4037/ajcc2001.10.5.367.
Larson MJ, Weaver LK, Hopkins RO. Cognitive sequelae in acute respiratory distress syndrome patients with and without recall of the intensive care unit. J Int Neuropsychol Soc 2007;13(04):595–605. DOI: 10.1017/S1355617707070749.
Reigle J. The ethics of physical restraints in critical care. AACN Adv Crit Care 1996;7(4):585–591. DOI: 10.1097/00044067-199611000-00014.
Wunderlich RJ, Perry A, Lavin MA, Katz B. Patients’ perceptions of uncertainty and stress during weaning from mechanical ventilation. Dimens Crit Care Nurs 1999;18(1):2–12. PMID: 10639993.
Kong E-H, Evans LK. Nursing staff views of barriers to physical restraint reduction in nursing homes. Asian Nurs Res 2012;6(4):173–180. DOI: 10.1016/j.anr.2012.10.007.
Martín IV, Pontón SC, Quintián GM, Velasco ST, Merino MM, Simón GM, et al. [Mechanical restraint: its use in intensive cares]. Enferm Intensiva 2011;23(4):164–170. DOI: 10.1016/j.enfi.2012.08.002.
Elm Ev, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335(7624):806–808. DOI: 10.1136/bmj.39335.541782.AD.
Mansouri P, Javadpour S, Zand F, Ghodsbin F, Sabetian G, Masjedi M, et al. Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial. J Crit Care 2013;28(6):918–922. DOI: 10.1016/j.jcrc.2013.06.019.
Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Journal of the American Medical Association 2001;286(21):2703–2710. DOI: 10.1001/jama.286.21.2703.
Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166(10):1338–1344. DOI: 10.1164/rccm.2107138.
Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012;186(8):724–731. DOI: 10.1164/rccm.201203-0522OC.
Tadrisi S, Madani S, Farmand F, Ebadi A, Karimi ZA, Saghafinia M, et al. Richmond agitation-sedation scale validity and reliability in intensive care unit adult patients. Persian version; 2009.
Ramazani J, Hosseini M. The assessment of APACHE II scoring system in predicting the result of weaning from ventilator. J Knowledge Health Basic Med Sci 2014;8(4):187–192. DOI: 10.1234/knh.v8i4.433.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829. PMID: 3928249.
van der Kooi AW, Peelen LM, Raijmakers RJ, Vroegop RL, Bakker DF, Tekatli H, et al. Use of physical restraints in Dutch intensive care units: a prospective multicenter study. Am J Crit Care 2015;24(6):488–495. DOI: 10.4037/ajcc2015348.
Kandeel NA, Attia AK. Physical restraints practice in adult intensive care units in Egypt. Nurs Health Sci 2013;15(1):79–85. DOI: 10.1111/nhs.12000.
Gu T, Wang X, Deng N, Weng W. Investigating influencing factors of physical restraint use in China intensive care units: a prospective, cross-sectional, observational study. Austr Crit Care 2019;32(3): 193–198. DOI: 10.1016/j.aucc.2018.05.002.
Suliman M. Prevalence of physical restraint among ventilated intensive care unit patients. J Clin Nurs 2018;27(19–20):3490–3496. DOI: 10.1111/jocn.14588.
Mehta S, Cook D, Devlin JW, Skrobik Y, Meade M, Fergusson D, et al. Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med 2015;43(3):557–566. DOI: 10.1097/CCM.0000000000000727.
Salehi Z, Joolaee S, Hajibabaee F, Ghezeljeh TN. The challenges of using physical restraint in intensive care units in Iran: a qualitative study. J Intensive Care Soc 2021;22(1):34–40. DOI: 10.1177/1751143719892785.
Krüger C, Mayer H, Haastert B, Meyer G. Use of physical restraints in acute hospitals in Germany: a multi-centre cross-sectional study. Int J Nurs Stud 2013;50(12):1599–1606. DOI: 10.1016/j.ijnurstu.2013. 05.005.
Hofmann H, Schorro E, Haastert B, Meyer G. Use of physical restraints in nursing homes: a multicentre cross-sectional study. BMC Geriatr 2015;15(1):1. DOI: 10.1186/s12877-015-0125-x.