• Thomas N Lawson, Alai Tan, Susan E Thrane, Mary Beth Happ, Lorraine C Mion, Judith Tate, and Michele C Balas.
• Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio.
• Am. J. Crit. Care. 2020 Mar 1; 29 (2): 9210292-102.

BackgroundPhysical restraints are frequently used for intensive care patients and are associated with substantial morbidity. The effects of common evidence-based critical care interventions on use of physical restraints remain unclear.ObjectiveTo identify independent predictors of new-onset use of physical restraints in critically ill adults.MethodsSecondary analysis of a prospective cohort study involving 5 adult intensive care units in a tertiary care medical center in the United States. Use of physical restraints was determined via daily in-person assessments and medical record review. Mixed-effects logistic regression analysis was used to examine factors associated with new-onset use of physical restraints, adjusting for covariates and within-subject correlation among intensive care unit days.ResultsOf 145 patients who were free of physical restraints within 48 hours of intensive care unit admission, 24 (16.6%) had restraints newly applied during their stay. In adjusted models, delirium (odds ratio [OR], 5.09; 95% CI, 1.83-14.14), endotracheal tube presence (OR, 3.47; 95% CI, 1.22-9.86), and benzodiazepine administration (OR, 3.17; 95% CI, 1.28-7.81) significantly increased the odds of next-day use of physical restraints. Tracheostomy was associated with significantly lowered odds of next-day restraint use (OR, 0.13; 95% CI, 0.02-0.73). Compared with patients with a target sedation level, patients who were in a coma (OR, 2.56; 95% CI, 0.80-8.18) or deeply sedated (OR, 2.53; 95% CI, 0.91-7.08) had higher odds of next-day use of physical restraints, and agitated patients (OR, 0.08; 95% CI, 0.00-2.07) were less likely to experience restraint use.ConclusionSeveral potentially modifiable risk factors are associated with next-day use of physical restraints.©2020 American Association of Critical-Care Nurses.

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