Psychotropic Drug Use in Physically Restrained, Critically Ill Adults Receiving Mechanical Ventilation
| Autor: | Alexandra Cheung, Louise Rose, Marlene Traille, Lisa Burry, Melanie Guenette, Sangeeta Mehta, Tara Farquharson, Ioanna Mantas |
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| Rok vydání: | 2017 |
| Předmět: |
Drug
Male Restraint Physical Critical Care media_common.quotation_subject medicine.medical_treatment Critical Illness Psychological intervention Critical Care Nursing 03 medical and health sciences 0302 clinical medicine Interquartile range Intervention (counseling) Medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study media_common Mechanical ventilation Psychotropic Drugs business.industry 030208 emergency & critical care medicine General Medicine Middle Aged Respiration Artificial Psychotropic drug Anesthesia Observational study Female business |
| Zdroj: | American journal of critical care : an official publication, American Association of Critical-Care Nurses. 26(5) |
| ISSN: | 1937-710X |
| Popis: | Background Restraining therapies (physical or pharmacological) are used to promote the safety of both patients and health care workers. Some guidelines recommend nonpharmacological or pharmacological interventions be used before physical restraints in critically ill patients. Objectives To characterize psychotropic drug interventions before and after use of physical restraints in critically ill adults receiving mechanical ventilation. Methods A single-center, prospective, observational study documenting psychotropic drug use and Sedation-Agitation Scale (SAS) scores in the 2 hours before and the 6 hours after application of physical restraints. Results Ninety-three patients were restrained for a median of 21 hours (interquartile range, 9-70 hours). Thirty percent of patients did not receive a psychotropic drug or had a drug stopped or decreased before physical restraints were applied. More patients received a psychotropic drug intervention after use of physical restraints than before (86% vs 56%, P = .001). Administration of opioids was more common after the use of physical restraints (54% vs 20% of patients, P = .001) and accounted for more drug interventions (45% vs 29%, P = .001). Fifty patients had SAS scores from both time periods; 16% remained oversedated, 24% were appropriately sedated, and 16% remained agitated in both time periods. Patients became oversedated (20%), more agitated (10%), less agitated (8%), and less sedated (6%) after restraint use. Conclusions Psychotropic drug interventions (mostly using opioids) were more common after use of physical restraints. Some patients may be physically restrained for anticipated treatment interference without consideration of pharmacological options and without documented agitation. |
| Databáze: | OpenAIRE |
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