Table 3.
Factors independently associated with number of days of physical restraints
|
Data point |
Univariable |
Multivariable |
|---|---|---|
| IRR a (95% CI) | IRR a (95% CI) | |
|
Patient characteristics |
|
|
| Age |
1.01 (0.99-1.04) |
1.00 (0.98-1.03) |
| Male sex |
0.87 (0.37-2.06) |
0.73 (0.35-1.54) |
| Psychiatric conditionb |
1.13 (0.35-3.67) |
1.27 (0.42-3.84) |
| Cognitive impairment (dementia) |
0.17 (0.01-2.86) |
0.28 (0.02-3.40) |
| Prior psychotropic drug usec |
0.60 (0.26-1.41) |
0.45 (0.19-1.06) |
| Smoking or alcohol consumption, habitual drug use |
1.68 (0.71-3.98) |
1.55 (0.73-3.27) |
| Patient category |
|
|
| Surgical |
1 |
1 |
| Medical |
1.48 (0.58-3.78) |
1.74 (0.72-4.22) |
| Other |
0.58 (0.19-1.72) |
0.61 (0.24-1.56) |
| APACHE II score |
0.97 (0.92-1.02) |
0.97 (0.92-1.02) |
|
Treatment characteristics |
|
|
| Medication use per mechanical ventilation days |
|
|
| Benzodiazepines (10 mg incrementsd) |
1.11 (1.05-1.17) |
1.07 (1.01-1.13) |
| Propofol (10 mg increments) |
1.00 (1.00-1.01) |
0.99 (0.99-1.00) |
| Opioids (10 mg incrementse) |
1.05 (1.00-1.01) |
1.00 (0.99-1.10) |
| Daily sedation interruption |
9.64 (4.23-21.94) |
3.44 (1.46-8.10) |
| Sedation administration |
|
|
| Intermittent use only |
1 |
1 |
| Continuous infusion only |
3.35 (0.93-12.16) |
0.87 (0.23-3.22) |
| Both |
23.47 (5.97-92.27) |
3.50 (0.88-13.89) |
| Antipsychotic prescription |
45.10 (18.56-109.62) |
15.67 (6.62-37.12) |
| Sedation-Agitation Scale scores |
|
|
| Agitation (SAS >4)f |
13.19 (4.12-42.15) |
1.99 (0.63-6.27) |
| Over-sedation (SAS <3)f |
11.04 (4.56-26.70) |
2.62 (1.08-6.35) |
| Adverse eventg |
20.45 (3.98-105.14) |
8.27 (2.07-33.08) |
|
Hospital and ICU
h
characteristics |
|
|
| University-affiliated hospital (vs. community) |
1.51 (0.63-3.61) |
0.46 (0.15-1.43) |
| Closed ICUh model (vs. open model) |
4.06 (1.34-12.26) |
0.86 (0.25-3.00) |
| Proportion of ventilator capable beds in the ICUh |
|
|
| <25% |
1 |
1 |
| 25-50% |
7.75 (0.87-69.27) |
15.82 (1.65-151.84) |
| 51-75% |
1.97 (0.23-16.68) |
5.99 (0.66-54.01) |
| 76-90% |
7.66 (0.92-63.51) |
31.76 (3.02-334.41) |
| >90% |
1.90 (0.16-22.47) |
10.31 (0.67-157.93) |
| Nurse to patient ratio ever <1:1 |
2.73 (1.08-6.89) |
1.75 (0.75-4.13) |
| Province |
|
|
| Ontario |
1 |
1 |
| Newfoundland and Labrador |
3.63 (0.35-38.16) |
3.59 (0.34-37.48) |
| Nova Scotia |
0.19 (0.00-14.37) |
1.87 (0.04-97.96) |
| New Brunswick |
0.53 (0.01-39.05) |
0.83 (0.01-46.75) |
| Prince Edward Island |
0.89 (0.04-21.49) |
7.47 (0.42-133.77) |
| Quebec |
2.74 (0.35-21.55) |
2.19 (0.31-15.38) |
| Manitoba |
1.40 (0.06-33.51) |
8.95 (0.38-212.36) |
| Saskatchewan |
0.44 (0.05-3.71) |
1.56 (0.17-14.82) |
| Alberta |
1.49 (0.05-47.70) |
0.85 (0.04-20.32) |
| British Columbia | 1.10 (0.16-7.64) | 0.93 (0.15-5.61) |
aIRR, incidence rate 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. APACHE II, Acute Physiology and Chronic Health Evaluation II.