Abstract
BackgroundPhysical restraint has been commonly indicated to patients with brain dysfunction in neurocritical care. The effect of physical restraints on outcomes of critically ill adults remains controversial as no randomized controlled trials have compared its safety and efficacy, and the association between physical restraint requirement and neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been fully examined. The aim of this study was to examine the association between physical restraint requirement and neurological outcomes in patients with SAH.MethodsA single-center, retrospective study was conducted on patients with acute phase SAH treated for > 72 h in the intensive care unit from 2014 to 2020. Patients were divided into three groups based on the amount of time required for physical restraint during the first 24–72 h after admission: no, intermittent, and continuous use of physical restraint. Unfavorable neurologic outcome, assessed using the modified Rankin scale upon hospital discharge, has been considered as primary end point.ResultsOverall, 101 patients were included in the study, with 52 patients (51.5%) having unfavorable neurological outcomes. Among them, 46 patients (45.5%) did not use physical restraint, and 55 (54.5%) patients used physical restraint during the first 24–72 h after admission: 26 (25.7%) intermittent and 29 (28.7%) continuous. Multivariable logistic regression analysis showed that continuous use of physical restraint during the first 24–72 h after admission was significantly associated with unfavorable neurological outcomes in patients with SAH (odds ratio, 3.54; 95% confidence interval, 1.05–13.06; p = 0.042) compared with no physical restraint.ConclusionsContinuous use of physical restraint during the first 24–72 h after admission was more significantly associated with unfavorable neurological outcomes than no physical restraint among patients with SAH during the acute phase.
Highlights
Physical restraint has been commonly indicated to patients with brain dysfunction in neurocritical care
Unfavorable neurological outcomes were observed in 52 patients (51.5%) (Table 1)
Multivariable logistic regression analysis Regarding the primary outcome, this study found that continuous use of physical restraint during the first 24– 72 h after admission was significantly associated with unfavorable neurological outcomes at discharge in patients with subarachnoid hemorrhage (SAH) (odds ratio (OR), 3.54; 95% confidence interval (CI), 1.05–13.06; p = 0.042) compared with no physical restraint (Table 3)
Summary
Physical restraint has been commonly indicated to patients with brain dysfunction in neurocritical care. The effect of physical restraints on outcomes of critically ill adults remains controversial as no randomized controlled trials have compared its safety and efficacy, and the association between physical restraint requirement and neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been fully examined. Physical restraint defined as “any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient’s movement” have been commonly indicated for patients with brain dysfunction in neurocritical care [1,2,3]. Its effect on outcomes of critically ill adult patients remains controversial as no randomized controlled trials (RCTs) have compared its safety and efficacy [1, 4]. The association between physical restraint requirement and neurological outcomes in patients with SAH has not been fully examined.
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