Table 2.
Factors independently associated with physical restraint use
|
Data point |
Univariable |
Multivariable |
|---|---|---|
| OR a (95% CI) | OR a (95% CI) | |
|
Patient characteristics |
|
|
| Age |
1.00 (0.99-1.01) |
1.00 (0.99-1.01) |
| Male sex |
0.98 (0.71-1.33) |
1.15 (0.78-1.69) |
| Psychiatric conditionb |
1.02 (0.66-1.56) |
0.86 (0.48-1.55) |
| Cognitive impairment (dementia) |
1.01 (0.36-2.81) |
1.42 (0.40-5.00) |
| Prior psychotropic drug usec |
0.91 (0.67-1.24) |
0.98 (0.64-1.50) |
| Smoking or alcohol consumption, habitual drug use |
0.99 (0.73-1.36) |
1.03 (0.70-1.53) |
| Patient category |
|
|
| Surgical |
1 |
1 |
| Medical |
0.93 (0.66-1.32) |
0.96 (0.60-1.52) |
| Other |
0.75 (0.51-1.11) |
0.96 (0.58-1.59) |
| APACHE II score |
0.99 (0.97-1.01) |
1.00 (0.97-1.02) |
|
Treatment characteristics |
|
|
| Medication use per mechanical ventilation days |
|
|
| Benzodiazepines (10 mg incrementsd) |
1.11 (1.06-1.16) |
1.05 (1.00-1.11) |
| Propofol (10 mg increments) |
1.00 (1.00-1.00) |
1.00 (1.00-1.00) |
| Opioids (10 mg incrementse) |
1.06 (1.04-1.09) |
1.04 (1.01-1.06) |
| Daily sedation interruption |
1.36 (1.00-1.84) |
1.46 (0.93-2.30) |
| Sedation administration |
|
|
| Intermittent use only |
1 |
1 |
| Continuous infusion only |
1.43 (0.93-2.21) |
1.39 (0.74-2.59) |
| Both |
4.14 (2.45-7.01) |
2.71 (1.35-5.43) |
| Antipsychotic prescription |
4.07 (2.50-6.64) |
3.09 (1.74-5.48) |
| Sedation-Agitation Scale scores |
|
|
| Agitation (SAS >4)f |
7.31 (3.27-16.36) |
3.73 (1.50-9.29) |
| Over-sedation (SAS <3)f |
2.74 (1.83-4.08) |
1.30 (0.77-2.20) |
| Adverse eventg |
2.44 (1.12-5.34) |
1.29 (0.53-3.15) |
|
Hospital and ICU
h
characteristics |
|
|
| University-affiliated hospital (vs. community) |
0.71 (0.51-0.99) |
0.32 (0.17-0.61) |
| Closed ICUh model (vs. open model) |
1.39 (0.95-2.04) |
0.59 (0.34-1.04) |
| Proportion of ventilator capable beds in the ICUh |
|
|
| <25% |
1 |
1 |
| 25-50% |
0.55 (0.25-1.21) |
0.99 (0.34-2.85) |
| 51-75% |
1.16 (0.52-2.56) |
2.97 (1.03-8.55) |
| 76-90% |
1.86 (0.83-4.15) |
8.34 (2.58-26.99) |
| >90% |
0.63 (0.26-1.52) |
1.97 (0.52-7.44) |
| Nurse to patient ratio ever <1:1 |
1.50 (1.05-2.15) |
0.81 (0.51-1.30) |
| Province |
|
|
| Ontario |
1 |
1 |
| Newfoundland and Labrador |
1.98 (1.00-3.89) |
1.55 (0.64-3.77) |
| Nova Scotia |
0.49 (0.15-1.67) |
0.37 (0.09-1.54) |
| New Brunswick |
/ |
/ |
| Prince Edward Island |
2.96 (0.79-11.15) |
4.23 (0.79-22.64) |
| Quebec |
1.42 (0.93-2.18) |
1.80 (0.99-3.29) |
| Manitoba |
4.44 (1.47-13.42) |
7.78 (2.13-28.46) |
| Saskatchewan |
0.49 (0.22-1.13) |
0.46 (0.15-1.42) |
| Alberta |
0.87 (0.56-1.34) |
1.31 (0.67-2.57) |
| British Columbia | 1.38 (0.43-4.45) | 1.02 (0.24-4.32) |
aOR, odds ratio; bpsychiatric condition included documented depression, anxiety, bipolar disorder, schizophrenia; cpsychotropic drugs included: sedative, narcotics, methadone, antidepressants; ddose expressed in midazolam equivalents (1 mg midazolam = 0.5 mg lorazepam); edose expressed in morphine equivalents (10 mg morphine = 2 mg hydromorphone = 0.1 mg fentanyl); fSedation-Agitation Scale; gadverse events comprised deliberate or accidental device removal (endotracheal tube, intravenous lines, feeding tubes, urinary catheters) by patients or accidental removal by staff, and danger to self or others; hICU, intensive care unit; /, low frequency counts did not allow for more accurate estimates. APACHE II, Acute Physiology and Chronic Health Evaluation II.