Hola a tod@s, my dear friends:
We continue with the week of #UciSinSujecciones (ICU free of restraints) and the truth is that we are delighted with the debate generated in the networks. At the moment, as well as the support and dissemination of colleagues Dr. Salvador Casado, Nightingaleandco, and so on, enfermeritico.com and nuestraenfermeria.es have been published content about this ítem in their blogs and from here we say thank you!. Together we add more.
Go ahead that IC-HU Project does not intended to convince or demonize anything or anyone else. We seek to carry out improvement measures as in other fields of Medicine (sepsis, mechanical ventilation, etc) in which there are no doubts about the need to investigate. And we believe that mechanical fastening must be the exception, not the rule, that´s why we have called to action and reflection.
And in this sense, it seems that on the issue of restraints, there are three factors: the ratios of personnel and the involvement of the whole team, the proper sedoanalgesia and the posibility of families to spend more time with their patients. Continue mulling.
So, I bring you the article Influence of Physical Restraint on Unplanned Extubation of Adult Intensive Care Patients: A Case-Control Study published in American Journal of Critical Care (AJCC) which, despite its methodology, it could help to dismantle the argument of… “if not holding the patient, there will be an unplanned extubation.”
As we all know, unplanned extubations are common in ICUs, and one of the methods to try to prevent them is the use of physical restraints. In this study, the authors not only conclude that they are not useful for this purpose, they can also to endanger the safety of the patient.
82% of the unplanned extubations occurred in patients with physical restraints, similar find in other studies and indicate not only that the subject is inadequate to prevent extubation, but which also promotes it.
They evaluated the effect of physical restraint on unplanned extubation of 300 participants between 1455 patients. Of them, 191 received physical restraint and their rate of unplanned extubation was the 42.9% vs. 16.5% in patients without any restraint.
The global rate of unplanned extubation was 8.7%, and the factors associated with it were the use of physical restraints (increased risk 3.11 times), nosocomial infection (increased risk 2.02 times) and a score of 9 or higher on the Glasgow Coma scale on admission to the unit (increases the risk, 1.98 times). These episodes were associated with longer stays in the unit.
In short, to reduce the risk of unplanned extubations, we must continue to seek other paths.
And that depends on every part of the scenario: patients, families and healthcare providers.