A Multicomponent Intervention Program to Prevent and Reduce ICU Agitation and Physical Restraint Use

Applying physical restraints (PR) has detrimental short- and long-term effects on patients and is increasingly seen as inhumane and outdated. Nonetheless, PR are still used in approximately 20-25% of all patients during their intensive care unit (ICU) stay in the Netherlands. The aim of this study is to determine the effectiveness of a person-centered multicomponent intervention (MCI) program consisting of non-pharmacological interventions combined with goal directed light sedation using dexmedetomidine compared to the old standard of care including physical restraints on short- and long-term outcomes and healthcare costs in (expected to become) agitated adult ICU patients.

Inclusion criteria

• Adult ICU patients (aged ≥18) with an expected ICU stay of >24 hours
• Patients who are (expected to become) agitated within the first 14 days of their ICU admission

Exclusion criteria

• Contra indication for dexmedetomidine use (i.e., AV-block grade 2 or 3 unless a pacemaker is present, uncontrolled hypotension, acute cerebrovascular condition or known/suspected hypersensitivity);
• Neurological patients with an (expected risk of) increased intracranial pressure;
• An intoxication as a result of drug abuse (e.g., ethanol, γ-Hydroxybutyrate, opioids, benzodiazepines);
• Support with Extracorporeal Membrane Oxygenation (ECMO);
• Difficult airway (e.g., a Cormack and Lehane laryngoscopy grade 4 view or a tumor causing airway obstruction);
• A high risk of physical aggression towards healthcare professionals;
• No consent for long term follow up in the MONITOR-IC study;
• Not able to read or understand the Dutch language and no relatives able to assist;
• Enrolment in other sedation studies.