IntroductionPhysical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.MethodsWe conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.ResultsPR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.ConclusionsPR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.

Nearly all MV patients received analgo-sedation. Opioids were used more often than sedatives despite infrequent use of pain scales. Few patients received antipsychotic therapy, but physical restraint was common. Protocol use was poor compared to DSI. Duration of MV predicted the use of either.

High analgo-sedation doses were associated with APACHE II scores, worsening gas exchange, and NMB use. Two thirds of patients received NMBs; use was highest on day 1 and subsequently declined. The percentage of patients who received NMB during HFOV in our study was lower than that previously reported. Future research should evaluate patient outcomes with and without use of NMBs, as well as the potential to manage patients with less sedation.

No abstract

No abstract

No abstract

Objective: To quantity the short-and long-term risks of severe maternal mental illness arising after a twin vs. singleton birth.Methods: This propensity-score weighted population-based retrospective cohort study comprised primiparous Canadian women aged 15-50 years. We compared 15,024 twin livebirths to 796,804 singletons livebirths, from 2003-2019. The primary composite outcome was a psychiatric emergency department visit, hospitalization, self-harm or suicide eventboth in the first year postpartum, and from 1 year postpartum up to 17 years post-delivery. Results:In the first year postpartum, after weighting, the rate of composite outcome events was 10.5 vs. 8.7 per 1000 person-years among twin and singleton births respectively (HR 1.21, 95% CI 1.07-1.47). Starting from 1 year postpartum, the corresponding rates were 5.9 vs. 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Conclusions:Women with a twin birth may experience more severe adverse mental health within 1-year postpartum, but not in the long-term.I would like to thank everyone who assisted me with my studies and contributed to this thesis project. Specifically, I would like to thank my supervisor, Dr. Simone Vigod for her enthusiasm in working with an ObGyn resident, and her assistance, support, and encouragement throughout the process. I would also like to thank my thesis committee consisting of Dr. Hilary Brown, Dr. Kellie Murphy, and Dr. Joel Ray for their engagement with this project and ongoing support and positive feedback, as well as Kinwah Fung for her data support at ICES. As well, I would like to thank the University of Toronto Department of Obstetrics and Gynecology, and specifically Dr. Michèle Farrugia and Dr. John Kingdom for their logistical and financial support which allowed me to complete this degree during my residency. Finally, I would like to thank my friends and family for supporting me through the challenges and celebrating my successes.

No abstract