Implementation of a Physical Restraint Decision Tree on Reducing Physical Restraint Use in an Adult Intensive Care Unit

ABSTRACT

Objective

To construct and evaluate a decision tool that minimizes physical restraint (PR) use while maintaining positive patient outcomes in an adult intensive care unit (ICU). It also aimed to understand nurses' perspectives regarding implementing the decision tool into routine ICU practice.

Design

A mixed-method design.

Methods

This study employed a mixed-method design, consisting of a Delphi study to develop a physical restraint decision tree (PRDT), a quasi-experimental study to evaluate the effect of PRDT on minimizing PR use in an adult ICU, and a qualitative interview to understand nurses' perspective and satisfaction of using the PRDT in daily practice. We compared the data on PR use and patient outcomes before and after applying the PRDT in an ICU.

Results

The PR rate was 48.1% before applying the PRDT from January to June 2018, significantly dropped to and maintained at 10.1% after implementing the PRDT from October 2018 to December 2022. After the implementation of the PRDT, the average length of ICU stays significantly reduced from 4.66 to 3.71 days; the average daily cost of ICU stays per patient dropped from 5084.13 CNY to 4312.02 CNY. No adverse events, such as catheter extrusion and fall, had occurred. Nurses encountered high satisfaction regarding integrating the PRDT into ICU practice.

Conclusions

The PRDT provides a structured, evidence-based approach to guide clinical decisions of lowering PR use in daily ICU practice. Implementation of the PRDT significantly reduced PR use without increasing adverse events.

Implications for Clinical Practice

The PRDT can serve as a tool for standardizing practices across the ICU, ensuring that restraint use is consistent with best practice guidelines and minimizing variability in care.

Reporting Method

SQUIRE 2.0 guidelines.

Patient or Public Contribution

No patient or public contribution.

Exosomes from bone marrow mesenchymal stem cells protect melanocytes under vitiligo-related conditions through induction of NRF2/HO1 expression

by Xuecheng Sun, Bo Huang, Gaobo Ruan, Aie Xu

Vitiligo, a chronic autoimmune disease linked to excess oxidative stress, can be temporarily improved. Bone marrow mesenchymal stem cells (BMSCs)-derived exosomes (BMSCs-Exos) have recently emerged as a promising novel therapeutic means for vitiligo.

Exosomes were isolated and characterized from BMSCs-conditioned medium. PIG3V cells and those transfected with NRF2 siRNA or negative control were cultured under normal conditions or exposure to hydrogen peroxide (H₂O₂) to induce oxidative stress, with addition of BMSCs-conditioned medium, conditioned medium from BMSCs pretreated with GW4869 (referred to as BMSCs-GW4869), or BMSCs-Exos. Cell viability, apoptosis, and oxidative stress parameters, including cellular glutathione (GSH)/oxidized glutathione (GSSG) ratio, superoxide dismutase (SOD), reactive oxygen species (ROS), and malondialdehyde (MDA), were assessed. The expression of Ki67, NRF2, HO1, BAC, and Bcl-2 was measured.

BMSC-Exos significantly enhanced cell viability and reduced apoptosis and oxidative stress in H₂O₂-treated PIG3V cells. Simultaneously, BMSCs-Exos reversed H₂O₂-induced downregulation of Ki67, NRF2, HO1, and Bcl-2, and upregulation of BAX in PIG3V cells. Silencing NRF2 by siRNA in PIG3V cells prior to H₂O₂ treatment abolished the protective effect of BMSCs-Exos and decreased the HO1 expression.

BMSCs-Exos protect melanocytes from vitiliog-related oxidative stress by mitigating oxidative damage through induction of NRF2/HO1 expression.