Comparison of the effect of two physical restraint type on the clinical outcomes of children under mechanical ventilation in pediatric intensive care unit: A crossover randomized clinical trial study

Abstract

Abstract Objective: The advancement of technology in the last few decades has increased the number of hospitalizations in children (1). Many patients hospitalized in ICU may experience some degree of agitation, one of the causes of which is intubation (8). Patient agitation is one of the primary reasons for the use of chemical or physical restraints in the ICU (5). The purpose of restraint is to limit the patient's freedom of movement and access to his body (18). Long-term physical restraint by reducing blood flow and pressure on the local nerves (27) leads to complications (17). Reducing patients' discomfort is one of the main reasons for care in the special care unit (46) and minimizing physical limitations is one of the most important goals of standard care (42). Therefore, the present study aims to compare the effect of two methods of physical restraint of the upper limbs on the clinical outcomes of children under mechanical ventilation. Methods: This study was conducted in the form of a randomized crossover clinical trial. In this research, children aged 6 months to 7 years under mechanical ventilation are the research sample (number of 48 people). The samples were randomly placed in two groups A and B. For group A, first the elbow was restrained for two hours and then the wrist was restrained for two hours. In group B, wrist restraints (for two hours) and then elbow restraints (for two hours) were applied. Before starting the intervention, a period of 15 minutes was considered as a wash out period. The results of the study were measured in three times before, during and after the intervention. To compare the clinical results, the clinical results registration checklist was used. Data analysis was done using SPSS version 20 statistical software. In this study, P value less than 0.05 was considered statistically significant. Findings: There was no significant difference in hand temperature in any of the restraints when examining the intervention of wrist restraints and elbow restraints. In the elbow restraint intervention, edema (P=0.000) and erythema (P=0.005) decreased during the intervention, but in the wrist restraint, no statistically significant difference was observed in these variables (P<0.05). A significant difference was observed in the values of radial pulse in both interventions, but there was a significant increase in the radial pulse in elbow restraints in the measurements (P=0.011) and a significant decrease in wrist restraints only during the intervention (P=0.013). Also, there was no significant difference in the agitation of children in the intervention of elbow restraint and wrist restraint. Discussion and conclusion: According to the results of the present study, all 4 cases of local outcome (temperature, edema, erythema, pulse) have significant differences in different states, but the level of agitation has not found a significant difference.