在重症患者中限制性与自由性的身体限制策略:R2D2-ICU随机临床试验
Romain Sonneville1,2, Camille Couffignal1,3, Florian Sigaud4
1Université Paris Cité, IAME, INSERM UMR 1137, Paris, France.
JAMA
|March 17, 2026
概括
低使用手腕带的身体克制策略并没有改善机械通风重症监护室 (ICU) 患者的结果. 与高使用限制相比,这种方法没有减少没有昏迷或妄想的日子.
科学领域:
- 关键护理医学 关键护理医学
- 患者安全 患者安全
- 机械通风机械通风机械通风
背景情况:
- 物理束,特别是手腕带对ICU机械通风患者的结果的影响尚未得到充分证实.
- 了解使用身体限制的最佳策略对于改善患者护理和安全至关重要.
研究的目的:
- 评估在需要侵入性机械通风的重症患者中,限制性,低使用率的手腕带身体限制策略与自由的,高使用率的策略之间的有效性.
- 为了确定较少使用手腕带是否会影响关键患者的治疗结果.
主要方法:
- 一项开放的随机临床试验,涉及法国10个重症监护室的405名成年患者.
- 患者被分配到低使用限制策略 (除非出现严重动荡,否则避免带) 或高使用策略 (系统应用和每日重新评估).
- 主要结局是随机化后14天内没有昏迷或妄想的生存日.
主要成果:
- 在低使用 (6.67天) 和高使用 (6.30天) 策略组之间,没有观察到没有昏迷或妄想的平均存活日的显著差异 (调整后的平均差异:0.37天;P=.51).
- 在这两组中,自我输出管的发生率相似 (9.2%的低使用者与8.5%的高使用者).
- 90日死亡率在低使用组为37.2%,在高使用组为41.0%.
结论:
- 在机械通风ICU患者中,低使用的手腕带身体克制策略在减少无昏迷或妄想的日子方面没有显示出与高使用策略相比的好处.
- 这些发现表明,当前在这个人群中使用手腕带的做法可能不会显著改变关键的神经和安全结果.
- 可能需要进一步的研究来探索替代的非约束策略来管理动荡,并预防呼吸器患者的不良事件.
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