array:24 [
  "pii" => "S2173572719300906"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2019.04.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-06-01"
  "aid" => "1271"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2019;43:299-301"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 407
    "formatos" => array:3 [
      "EPUB" => 76
      "HTML" => 215
      "PDF" => 116
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569118302663"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2018.09.005"
      "estado" => "S300"
      "fechaPublicacion" => "2019-06-01"
      "aid" => "1271"
      "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Med Intensiva. 2019;43:299-301"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1367
        "formatos" => array:3 [
          "EPUB" => 69
          "HTML" => 984
          "PDF" => 314
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">PUNTO DE VISTA</span>"
        "titulo" => "La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "299"
            "paginaFinal" => "301"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Reducing the use of physical restraints&#44; a pending and emerging matter at the ICU"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1752
                "Ancho" => 2500
                "Tamanyo" => 273442
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Modelo reflexivo de uso de contenciones mec&#225;nicas&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DAD&#58; dolor&#47;agitaci&#243;n&#47;delirio&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Modificada de Via-Clavero et al&#46; Consideraciones &#233;tico-legales y cl&#237;nicas del uso de contenciones&#46; Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona &#40;COIB&#41;&#46; Pendiente de publicaci&#243;n&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Acevedo-Nuevo, G&#46; Via-Clavero"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Acevedo-Nuevo"
              ]
              1 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Via-Clavero"
              ]
              2 => array:1 [
                "colaborador" => "en nombre del Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572719300906"
          "doi" => "10.1016/j.medine.2019.04.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300906?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118302663?idApp=WMIE"
      "url" => "/02105691/0000004300000005/v2_201906050809/S0210569118302663/v2_201906050809/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572719300979"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2019.05.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-06-01"
    "aid" => "1300"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2019;43:302-16"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2188
      "formatos" => array:3 [
        "EPUB" => 60
        "HTML" => 1866
        "PDF" => 262
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus statement</span>"
      "titulo" => "Practical document on the management of hyponatremia in critically ill patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "302"
          "paginaFinal" => "316"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Documento pr&#225;ctico del manejo de la hiponatremia en pacientes cr&#237;ticos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1861
              "Ancho" => 3390
              "Tamanyo" => 333731
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hyponatremia diagnostic algorithm&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;J&#46; Broch Porcar, B&#46; Rodr&#237;guez Cubillo, J&#46;M&#46; Dom&#237;nguez-Rold&#225;n, L&#46; &#193;lvarez Rocha, M&#46;&#193;&#46; Ballesteros Sanz, M&#46; Cervera Montes, M&#46; Chico Fern&#225;ndez, J&#46;H&#46; de Gea Garc&#237;a, P&#46; Enr&#237;quez Giraudo, A&#46; Garc&#237;a de Lorenzo y Mateos, R&#46; G&#243;mez L&#243;pez, R&#46; Guerrero Pav&#243;n, F&#46; L&#243;pez S&#225;nchez, J&#46;A&#46; Llompart-Pou, S&#46; Lubillo Montenegro, Z&#46; Molina Collado, P&#46; Ram&#237;rez Galleymore, M&#46; Riveiro Vilaboa, A&#46; S&#225;nchez Corral, M&#46;E&#46; Herrera-Guti&#233;rrez"
          "autores" => array:20 [
            0 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Broch Porcar"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Rodr&#237;guez Cubillo"
            ]
            2 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Dom&#237;nguez-Rold&#225;n"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "&#193;lvarez Rocha"
            ]
            4 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Ballesteros Sanz"
            ]
            5 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Cervera Montes"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Chico Fern&#225;ndez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;H&#46;"
              "apellidos" => "de Gea Garc&#237;a"
            ]
            8 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Enr&#237;quez Giraudo"
            ]
            9 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a de Lorenzo y Mateos"
            ]
            10 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "G&#243;mez L&#243;pez"
            ]
            11 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Guerrero Pav&#243;n"
            ]
            12 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "L&#243;pez S&#225;nchez"
            ]
            13 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Llompart-Pou"
            ]
            14 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Lubillo Montenegro"
            ]
            15 => array:2 [
              "nombre" => "Z&#46;"
              "apellidos" => "Molina Collado"
            ]
            16 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Ram&#237;rez Galleymore"
            ]
            17 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Riveiro Vilaboa"
            ]
            18 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "S&#225;nchez Corral"
            ]
            19 => array:2 [
              "nombre" => "M&#46;E&#46;"
              "apellidos" => "Herrera-Guti&#233;rrez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569118303358"
        "doi" => "10.1016/j.medin.2018.12.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118303358?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300979?idApp=WMIE"
    "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300979/v1_201906010831/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173572719300827"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2018.01.015"
    "estado" => "S300"
    "fechaPublicacion" => "2019-06-01"
    "aid" => "1170"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "rev"
    "cita" => "Med Intensiva. 2019;43:290-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 364
      "formatos" => array:3 [
        "EPUB" => 55
        "HTML" => 184
        "PDF" => 125
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Narrative review of pediatric critical care humanization&#58; Where we are&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "290"
          "paginaFinal" => "298"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Revisi&#243;n narrativa sobre humanizaci&#243;n en cuidados intensivos pedi&#225;tricos&#58; &#191;d&#243;nde estamos&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1354
              "Ancho" => 2167
              "Tamanyo" => 147513
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Identification of the turning point in a patient&#39;s progression of a disease and initiation of treatment adequacy based on the patient&#39;s needs&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Garc&#237;a-Salido, G&#46; Heras la Calle, A&#46; Serrano Gonz&#225;lez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-Salido"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Heras la Calle"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Serrano Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569118300172"
        "doi" => "10.1016/j.medin.2018.01.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118300172?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300827?idApp=WMIE"
    "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300827/v1_201906010831/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>"
    "titulo" => "Reducing the use of physical restraints&#44; a pending and emerging matter at the ICU"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "299"
        "paginaFinal" => "301"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Acevedo-Nuevo, G&#46; Via-Clavero"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Acevedo-Nuevo"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Via-Clavero"
            "email" => array:1 [
              0 => "gviac@ub.edu"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:1 [
            "colaborador" => "Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias"
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Hospital Universitario Puerta de Hierro&#44; Majadahonda&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Aut&#243;noma de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Escuela Universitaria de Enfermer&#237;a&#44; Facultad de Medicina y Ciencias de la Salud&#44; Universidad de Barcelona&#44; Grup de Recerca Infermera &#40;GRIN&#41;&#44; Institut d&#8217;Investigaci&#243; Biom&#232;dica de Bellvitge &#40;IDIBELL&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1754
            "Ancho" => 2500
            "Tamanyo" => 265656
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reflective model on the use of physical restraint measures&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PAD&#58; pain&#47;agitation&#47;delirium&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adapted from Via-Clavero et al&#46; Ethical-legal and clinical considerations on the use of restraining measures&#46; Official College of Nurses of Barcelona &#40;<span class="elsevierStyleItalic">Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona</span> &#91;COIB&#93;&#41;&#46; Pending publication&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physical restraint &#40;PR&#41; applied to the wrists or ankles&#44; or using mitts or belts&#44; is common practice in the Intensive Care Unit &#40;ICU&#41;&#44; and seeks to limit movement of the body or part of the body of the patient&#46; In intensive care&#44; PR is particularly used in patients subjected to mechanical ventilation or who suffer agitation of hyperactive delirium&#44; in order to avoid self-extubation or removal of other life support devices&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In late 2017&#44; <span class="elsevierStyleItalic">Intensive Care Medicine</span>&#44; as the official journal of the European Society of Intensive Care Medicine&#44; published an article entitled&#58; <span class="elsevierStyleItalic">Physical restraint&#58; Time to let go</span>&#44; in which the authors encouraged readers to reflect upon the use of PR in critical patients&#44; and positioned themselves against such practices&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> More recently&#44; the new guides on the management of pain&#44; sedation&#47;agitation&#44; delirium&#44; immobilization and sleep &#40;PADIS guides&#41; have underscored the need for randomized clinical trials to assess the true effects of PR upon patient clinical outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To date&#44; the few studies that have focused on the use of PR in the ICU have reported high and notoriously variable prevalences from one country to another&#44; and even between hospitals in one same country&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;5</span></a> though the criteria used to measure prevalence are heterogeneous &#8211; a fact that makes comparisons difficult&#46; What does seem clear&#44; however&#44; is that PR is common practice in most countries&#44; with the exception of the United Kingdom and in northern Europe&#46; In contrast&#44; Spain appears to be one of the countries in which PR is most widely used&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On examining the evidence on the use of PR in critical patients&#44; most studies agree that its effectiveness in avoiding falls or in preventing patient self-removal of devices is uncertain and inconclusive&#46; Indeed&#44; PR has even been reported to induce such self-removal&#44; possibly mediated by increased patient agitation caused by the use of PR&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Acknowledging the limitations of many of these studies&#44; at present we are only able to conclude that PR has not been shown to significantly reduce the incidence of patient self-removal of devices in the ICU&#44; while in contrast the use of such measures of restraint has been found to predispose to increased patient agitation and risk of delirium&#46; The benefits and safety of PR is therefore widely questioned&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">From the professional responsibility perspective&#44; the avoidance of PR should be mandatory&#44; with the purpose of affording &#8220;good care&#8221; in which psychological&#44; emotional and ethical management is placed on a par with physical care&#46; In addition to limiting autonomy&#44; using PR places the patient in a situation of increased vulnerability&#46; Unfortunately&#44; current legislation &#8211; derived from other general laws such as those referred to informed consent or contexts as different as mental health or the sociosanitary setting &#8211; is not clear when it comes to defining the position to be taken in contexts as dynamic and variable as those found in the ICU&#46; It seems clear that the adoption of restraining measures must be guided by the principles of good medical practice&#59; provided all verbal&#44; relational and pharmacological alternatives have been exhausted&#59; and conditioned to the obtainment of consent from the patient &#40;or family&#44; when the former is unable to give consent&#41;&#46; In any case&#44; the decision always must be made on a team consensus basis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Many studies indicate that one of the main reasons for using PR is to control disruptive or &#8220;uncooperative&#8221; behavior on the part of the patient&#46; However&#44; these studies offer no in-depth analysis of the possible causes of such behavior&#44; e&#46;g&#46;&#44; pain or delirium&#44; and simply label all these manifestations as corresponding to an &#8220;agitated patient&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> This lack of analysis may be a consequence of failure to recognize the use of PR as a multifactorial and highly complex phenomenon&#46; In this respect&#44; qualitative studies published in recent years offer an in-depth exploration of the opinions and beliefs regarding the factors both against and in favor of the use of PR&#44; particularly the prevention and management of pain&#44; agitation and delirium within the Units&#44; as influencing factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;12</span></a> These studies show PR to be a shared responsibility within the care team&#44; in which each professional plays a key role&#46; The most current theoretical models&#44; such as eCash&#44; coincide that the use of PR must be tied to patient wellbeing in the ICU&#44; and that the prevention&#44; monitoring and treatment &#40;whether pharmacological or otherwise&#41; of pain&#44; agitation and delirium&#44; such as multimodal analgesia&#44; dexmedetomidine&#44; early mobilization&#44; respect for sleep&#44; and family accompaniment&#44; are interdisciplinary issues that require joint effort&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another frequent claim is the need to relate work load and the nurse-to-patient ratio to the use of PR&#46; However&#44; this argument likewise does not appear to stand up to the evidence&#44; since the use of PR remains common in Units with a ratio of 1&#58;1&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> and although it is true that the ratios should be adjusted to the work load&#44; this solution nowadays is neither realistic nor feasible&#46; What does seem clear is that continuous vigilance and accompaniment at the patient bedside would contribute to avoid the need for PR&#46; In this regard a fundamental requirement is the commitment of organizations to policies of change designed to promote accompaniment by the family and shared and reflective decision making by all the members of the team&#46; The approach to minimizing PR in the ICU should be a multicomponent initiative adapted to each organization and focused on the reality of each center&#44; with the purpose of creating a new &#8220;culture of care&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The proposals made by both the Analgesia&#44; Sedation&#44; Restraint and Delirium Working Group of the Spanish Society of Nursing in Intensive Care and Coronary Units &#40;<span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias</span> &#91;SEEIUC&#93;&#41; and the Sedation&#44; Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;<span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias</span> &#91;SEMICYUC&#93;&#41; comprise a joint approach to these problems&#44; integrating the use of PR with aspects related to pain&#44; agitation and delirium&#44; and advocate an interdisciplinary perspective&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> In this regard&#44; the &#8220;do not do&#8221; recommendations of the Sedation&#44; Analgesia and Delirium Working Group of the SEMICYUC specifically contemplate the avoidance of PR as a delirium preventive measure&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Likewise&#44; the Analgesia&#44; Sedation&#44; Restraint and Delirium Working Group is obtaining real data from multicenter studies in our setting on the management of pain&#44; agitation and delirium&#44; factors related to the use of PR and patient self-removal of devices&#44; and information referred to the suitability of use of PR &#40;prescription&#44; registry&#44; written informed consent&#44; duration of the measure&#44; etc&#46;&#41; in order to allow comparisons to be made in our context&#44; as well as to establish cautious extrapolations referred to the international setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It seems that the challenge of reflection and progress toward PR-free critical care has finally been accepted&#46; However&#44; in order for such progress to be adequate&#44; we need to acknowledge our reality and difficulties&#44; open our perspective and ask research questions referred to more reflective and inclusive strategies&#44; with innovative and interdisciplinary initiatives in which institutional implication is also present&#46; Only in this way can we advance from the current position on the adequate management of PR as a pending and emerging matter in the ICU&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-25"
    "fechaAceptado" => "2018-09-04"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Acevedo-Nuevo M&#44; Via-Clavero G&#44; en nombre del Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias&#46; La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI&#46; Med Intensiva&#46; 2019&#59;43&#58;299&#8211;301&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1754
            "Ancho" => 2500
            "Tamanyo" => 265656
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reflective model on the use of physical restraint measures&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PAD&#58; pain&#47;agitation&#47;delirium&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adapted from Via-Clavero et al&#46; Ethical-legal and clinical considerations on the use of restraining measures&#46; Official College of Nurses of Barcelona &#40;<span class="elsevierStyleItalic">Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona</span> &#91;COIB&#93;&#41;&#46; Pending publication&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; risk factors&#44; and outcomes associated with physical restraint use in mechanically ventilated adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Rose"
                            1 => "L&#46; Burry"
                            2 => "R&#46; Mallick"
                            3 => "E&#46; Luk"
                            4 => "D&#46; Cook"
                            5 => "D&#46; Fergusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2015.09.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "31"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26489482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit&#58; Use of restraining therapies &#8211; American College of Critical Care Medicine Task Force 2001&#8211;2002"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;A&#46; Maccioli"
                            1 => "T&#46; Dorman"
                            2 => "B&#46;R&#46; Brown"
                            3 => "J&#46;E&#46; Mazuski"
                            4 => "B&#46;A&#46; McLean"
                            5 => "J&#46;M&#46; Kuszaj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000095463.72353.AD"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "2665"
                        "paginaFinal" => "2676"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical restraint&#58; time to let go"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Burry"
                            1 => "L&#46; Rose"
                            2 => "B&#46; Ricou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2018"
                        "volumen" => "44"
                        "paginaInicial" => "1296"
                        "paginaFinal" => "1298"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical Practice Guidelines for the prevention and management of pain&#44; agitation&#47;sedation&#44; delirium&#44; immobility&#44; and sleep disruption in adult patients in the ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Devlin"
                            1 => "Y&#46; Skrobik"
                            2 => "C&#46; G&#233;linas"
                            3 => "D&#46;M&#46; Needham"
                            4 => "A&#46;J&#46;C&#46; Slooter"
                            5 => "P&#46;P&#46; Pandharipande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2018"
                        "volumen" => "46"
                        "paginaInicial" => "e825"
                        "paginaFinal" => "e873"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical restraint use in intensive care units across Europe&#58; the PRICE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Benbenbishty"
                            1 => "S&#46; Adam"
                            2 => "R&#46; Endacott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Crit Care Nurs"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "241"
                        "paginaFinal" => "245"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contenci&#243;n mec&#225;nica&#58; su uso en cuidados intensivos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Mart&#237;n Iglesias"
                            1 => "C&#46; Pont&#243;n Soriano"
                            2 => "M&#46;T&#46; Quinti&#225;n Guerra"
                            3 => "T&#46;R&#46; Velasco Sanz"
                            4 => "M&#46;R&#46; Merino Mart&#237;nez"
                            5 => "M&#46;J&#46; Sim&#243;n Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.enfi.2012.08.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "164"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23041321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restricciones f&#237;sicas en UCI&#44; su utilizaci&#243;n y percepci&#243;n de pacientes y familiares"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;I&#46; P&#233;rez de Ciriza Amatriain"
                            1 => "A&#46; Nicol&#225;s Olmedo"
                            2 => "R&#46; Go&#241;i Viguria"
                            3 => "E&#46; Regaira Mart&#237;nez"
                            4 => "M&#46;A&#46; Margall Coscojuela"
                            5 => "M&#46;C&#46; Asiain Erro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with unplanned extubation in the Intensive Care Unit for adult patients&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Z&#46;P&#46; Ai"
                            1 => "X&#46;L&#46; Gao"
                            2 => "X&#46;L&#46; Zhao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.iccn.2018.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Crit Care Nurs"
                        "fecha" => "2018"
                        "volumen" => "47"
                        "paginaInicial" => "62"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29653888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; risk factors&#44; and outcomes of delirium in mechanically ventilated adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mehta"
                            1 => "D&#46; Cook"
                            2 => "J&#46;W&#46; Devlin"
                            3 => "Y&#46; Skrobik"
                            4 => "M&#46; Meade"
                            5 => "D&#46; Fergusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "557"
                        "paginaFinal" => "566"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient agitation and its management in adult critical care&#58; a systematic review and narrative synthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Freeman"
                            1 => "J&#46; Yorke"
                            2 => "P&#46; Dark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocn.14258"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Nurs"
                        "fecha" => "2018"
                        "volumen" => "27"
                        "paginaInicial" => "e1284"
                        "paginaFinal" => "e1308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29314320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manejo de la inmovilizaci&#243;n terap&#233;utica en Unidades de Cuidados Cr&#237;ticos&#58; aproximaci&#243;n fenomenol&#243;gica a la realidad enfermera"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Acevedo-Nuevo"
                            1 => "M&#46;T&#46; Gonz&#225;lez-Gil"
                            2 => "M&#46; Sol&#237;s-Mu&#241;oz"
                            3 => "N&#46; L&#225;iz-D&#237;ez"
                            4 => "M&#46;J&#46; Tora&#241;o-Olivera"
                            5 => "L&#46;F&#46; Carrasco-Rodr&#237;guez-Rey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.enfi.2015.11.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "62"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26805701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eliciting critical care nurses&#8217; beliefs regarding physical restraint use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Via-Clavero"
                            1 => "M&#46; Sanju&#225;n-Nav&#225;is"
                            2 => "M&#46; Romero-Garc&#237;a"
                            3 => "L&#46; de la Cueva-Ariza"
                            4 => "G&#46; Mart&#237;nez-Estalella"
                            5 => "E&#46; Plata-Menchaca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0969733017752547"
                      "Revista" => array:2 [
                        "tituloSerie" => "Nurs Ethics"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comfort and patient-centred care without excessive sedation&#58; the eCASH concept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Vincent"
                            1 => "Y&#46; Shehabi"
                            2 => "T&#46;S&#46; Walsh"
                            3 => "P&#46;P&#46; Pandharipande"
                            4 => "J&#46;A&#46; Ball"
                            5 => "P&#46; Spronk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-016-4297-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "962"
                        "paginaFinal" => "971"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27075762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones para el tratamiento de los pacientes cr&#237;ticos de los Grupos de Trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Hern&#225;ndez-Tejedor"
                            1 => "O&#46; Pe&#241;uelas"
                            2 => "G&#46; Sirgo-Rodr&#237;guez"
                            3 => "J&#46; Llompart-Pou"
                            4 => "E&#46; Palencia-Herrej&#243;n"
                            5 => "A&#46; Estella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2017.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "285"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28476212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones de &#171;no hacer&#187; en el tratamiento de los pacientes cr&#237;ticos de los grupos de trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Gonz&#225;lez de Molina Ortiz"
                            1 => "F&#46; Gordo Vidal"
                            2 => "A&#46; Estella Garc&#237;a"
                            3 => "P&#46; Morrondo Valdeolmillos"
                            4 => "J&#46;F&#46; Fern&#225;ndez Ortega"
                            5 => "J&#46; Caballero L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2018.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2018"
                        "volumen" => "42"
                        "paginaInicial" => "425"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29789183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300906/v1_201906010831/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "402"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Point of view"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000005/v1_201906010831/S2173572719300906/v1_201906010831/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300906?idApp=WMIE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Point of view
Reducing the use of physical restraints, a pending and emerging matter at the ICU
La reducción del uso de contenciones mecánicas, una asignatura pendiente y emergente en las UCI
M. Acevedo-Nuevoa,b,c, G. Via-Claveroc,d,e,
Corresponding author
gviac@ub.edu

Corresponding author.
, Grupo de Trabajo Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias
a Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Universidad Autónoma de Madrid, Madrid, Spain
c Grupo de Trabajo Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias, Madrid, Spain
d Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Escuela Universitaria de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Grup de Recerca Infermera (GRIN), Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
Read
7355
Times
was read the article
2329
Total PDF
5026
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173572719300906"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2019.04.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-06-01"
  "aid" => "1271"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2019;43:299-301"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 407
    "formatos" => array:3 [
      "EPUB" => 76
      "HTML" => 215
      "PDF" => 116
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569118302663"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2018.09.005"
      "estado" => "S300"
      "fechaPublicacion" => "2019-06-01"
      "aid" => "1271"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Med Intensiva. 2019;43:299-301"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1367
        "formatos" => array:3 [
          "EPUB" => 69
          "HTML" => 984
          "PDF" => 314
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">PUNTO DE VISTA</span>"
        "titulo" => "La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "299"
            "paginaFinal" => "301"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Reducing the use of physical restraints&#44; a pending and emerging matter at the ICU"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1752
                "Ancho" => 2500
                "Tamanyo" => 273442
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Modelo reflexivo de uso de contenciones mec&#225;nicas&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DAD&#58; dolor&#47;agitaci&#243;n&#47;delirio&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Modificada de Via-Clavero et al&#46; Consideraciones &#233;tico-legales y cl&#237;nicas del uso de contenciones&#46; Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona &#40;COIB&#41;&#46; Pendiente de publicaci&#243;n&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Acevedo-Nuevo, G&#46; Via-Clavero"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Acevedo-Nuevo"
              ]
              1 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Via-Clavero"
              ]
              2 => array:1 [
                "colaborador" => "en nombre del Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572719300906"
          "doi" => "10.1016/j.medine.2019.04.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300906?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118302663?idApp=WMIE"
      "url" => "/02105691/0000004300000005/v2_201906050809/S0210569118302663/v2_201906050809/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572719300979"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2019.05.005"
    "estado" => "S300"
    "fechaPublicacion" => "2019-06-01"
    "aid" => "1300"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2019;43:302-16"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2188
      "formatos" => array:3 [
        "EPUB" => 60
        "HTML" => 1866
        "PDF" => 262
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Consensus statement</span>"
      "titulo" => "Practical document on the management of hyponatremia in critically ill patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "302"
          "paginaFinal" => "316"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Documento pr&#225;ctico del manejo de la hiponatremia en pacientes cr&#237;ticos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1861
              "Ancho" => 3390
              "Tamanyo" => 333731
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hyponatremia diagnostic algorithm&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;J&#46; Broch Porcar, B&#46; Rodr&#237;guez Cubillo, J&#46;M&#46; Dom&#237;nguez-Rold&#225;n, L&#46; &#193;lvarez Rocha, M&#46;&#193;&#46; Ballesteros Sanz, M&#46; Cervera Montes, M&#46; Chico Fern&#225;ndez, J&#46;H&#46; de Gea Garc&#237;a, P&#46; Enr&#237;quez Giraudo, A&#46; Garc&#237;a de Lorenzo y Mateos, R&#46; G&#243;mez L&#243;pez, R&#46; Guerrero Pav&#243;n, F&#46; L&#243;pez S&#225;nchez, J&#46;A&#46; Llompart-Pou, S&#46; Lubillo Montenegro, Z&#46; Molina Collado, P&#46; Ram&#237;rez Galleymore, M&#46; Riveiro Vilaboa, A&#46; S&#225;nchez Corral, M&#46;E&#46; Herrera-Guti&#233;rrez"
          "autores" => array:20 [
            0 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Broch Porcar"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Rodr&#237;guez Cubillo"
            ]
            2 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Dom&#237;nguez-Rold&#225;n"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "&#193;lvarez Rocha"
            ]
            4 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Ballesteros Sanz"
            ]
            5 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Cervera Montes"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Chico Fern&#225;ndez"
            ]
            7 => array:2 [
              "nombre" => "J&#46;H&#46;"
              "apellidos" => "de Gea Garc&#237;a"
            ]
            8 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Enr&#237;quez Giraudo"
            ]
            9 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a de Lorenzo y Mateos"
            ]
            10 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "G&#243;mez L&#243;pez"
            ]
            11 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Guerrero Pav&#243;n"
            ]
            12 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "L&#243;pez S&#225;nchez"
            ]
            13 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Llompart-Pou"
            ]
            14 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Lubillo Montenegro"
            ]
            15 => array:2 [
              "nombre" => "Z&#46;"
              "apellidos" => "Molina Collado"
            ]
            16 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Ram&#237;rez Galleymore"
            ]
            17 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Riveiro Vilaboa"
            ]
            18 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "S&#225;nchez Corral"
            ]
            19 => array:2 [
              "nombre" => "M&#46;E&#46;"
              "apellidos" => "Herrera-Guti&#233;rrez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569118303358"
        "doi" => "10.1016/j.medin.2018.12.002"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118303358?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300979?idApp=WMIE"
    "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300979/v1_201906010831/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173572719300827"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2018.01.015"
    "estado" => "S300"
    "fechaPublicacion" => "2019-06-01"
    "aid" => "1170"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "rev"
    "cita" => "Med Intensiva. 2019;43:290-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 364
      "formatos" => array:3 [
        "EPUB" => 55
        "HTML" => 184
        "PDF" => 125
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Narrative review of pediatric critical care humanization&#58; Where we are&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "290"
          "paginaFinal" => "298"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Revisi&#243;n narrativa sobre humanizaci&#243;n en cuidados intensivos pedi&#225;tricos&#58; &#191;d&#243;nde estamos&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1354
              "Ancho" => 2167
              "Tamanyo" => 147513
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Identification of the turning point in a patient&#39;s progression of a disease and initiation of treatment adequacy based on the patient&#39;s needs&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Garc&#237;a-Salido, G&#46; Heras la Calle, A&#46; Serrano Gonz&#225;lez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Garc&#237;a-Salido"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Heras la Calle"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Serrano Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569118300172"
        "doi" => "10.1016/j.medin.2018.01.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118300172?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300827?idApp=WMIE"
    "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300827/v1_201906010831/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>"
    "titulo" => "Reducing the use of physical restraints&#44; a pending and emerging matter at the ICU"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "299"
        "paginaFinal" => "301"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Acevedo-Nuevo, G&#46; Via-Clavero"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Acevedo-Nuevo"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Via-Clavero"
            "email" => array:1 [
              0 => "gviac@ub.edu"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:1 [
            "colaborador" => "Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias"
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Hospital Universitario Puerta de Hierro&#44; Majadahonda&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Aut&#243;noma de Madrid&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Escuela Universitaria de Enfermer&#237;a&#44; Facultad de Medicina y Ciencias de la Salud&#44; Universidad de Barcelona&#44; Grup de Recerca Infermera &#40;GRIN&#41;&#44; Institut d&#8217;Investigaci&#243; Biom&#232;dica de Bellvitge &#40;IDIBELL&#41;&#44; Barcelona&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1754
            "Ancho" => 2500
            "Tamanyo" => 265656
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reflective model on the use of physical restraint measures&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PAD&#58; pain&#47;agitation&#47;delirium&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adapted from Via-Clavero et al&#46; Ethical-legal and clinical considerations on the use of restraining measures&#46; Official College of Nurses of Barcelona &#40;<span class="elsevierStyleItalic">Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona</span> &#91;COIB&#93;&#41;&#46; Pending publication&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physical restraint &#40;PR&#41; applied to the wrists or ankles&#44; or using mitts or belts&#44; is common practice in the Intensive Care Unit &#40;ICU&#41;&#44; and seeks to limit movement of the body or part of the body of the patient&#46; In intensive care&#44; PR is particularly used in patients subjected to mechanical ventilation or who suffer agitation of hyperactive delirium&#44; in order to avoid self-extubation or removal of other life support devices&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In late 2017&#44; <span class="elsevierStyleItalic">Intensive Care Medicine</span>&#44; as the official journal of the European Society of Intensive Care Medicine&#44; published an article entitled&#58; <span class="elsevierStyleItalic">Physical restraint&#58; Time to let go</span>&#44; in which the authors encouraged readers to reflect upon the use of PR in critical patients&#44; and positioned themselves against such practices&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> More recently&#44; the new guides on the management of pain&#44; sedation&#47;agitation&#44; delirium&#44; immobilization and sleep &#40;PADIS guides&#41; have underscored the need for randomized clinical trials to assess the true effects of PR upon patient clinical outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To date&#44; the few studies that have focused on the use of PR in the ICU have reported high and notoriously variable prevalences from one country to another&#44; and even between hospitals in one same country&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;5</span></a> though the criteria used to measure prevalence are heterogeneous &#8211; a fact that makes comparisons difficult&#46; What does seem clear&#44; however&#44; is that PR is common practice in most countries&#44; with the exception of the United Kingdom and in northern Europe&#46; In contrast&#44; Spain appears to be one of the countries in which PR is most widely used&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On examining the evidence on the use of PR in critical patients&#44; most studies agree that its effectiveness in avoiding falls or in preventing patient self-removal of devices is uncertain and inconclusive&#46; Indeed&#44; PR has even been reported to induce such self-removal&#44; possibly mediated by increased patient agitation caused by the use of PR&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> Acknowledging the limitations of many of these studies&#44; at present we are only able to conclude that PR has not been shown to significantly reduce the incidence of patient self-removal of devices in the ICU&#44; while in contrast the use of such measures of restraint has been found to predispose to increased patient agitation and risk of delirium&#46; The benefits and safety of PR is therefore widely questioned&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">From the professional responsibility perspective&#44; the avoidance of PR should be mandatory&#44; with the purpose of affording &#8220;good care&#8221; in which psychological&#44; emotional and ethical management is placed on a par with physical care&#46; In addition to limiting autonomy&#44; using PR places the patient in a situation of increased vulnerability&#46; Unfortunately&#44; current legislation &#8211; derived from other general laws such as those referred to informed consent or contexts as different as mental health or the sociosanitary setting &#8211; is not clear when it comes to defining the position to be taken in contexts as dynamic and variable as those found in the ICU&#46; It seems clear that the adoption of restraining measures must be guided by the principles of good medical practice&#59; provided all verbal&#44; relational and pharmacological alternatives have been exhausted&#59; and conditioned to the obtainment of consent from the patient &#40;or family&#44; when the former is unable to give consent&#41;&#46; In any case&#44; the decision always must be made on a team consensus basis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Many studies indicate that one of the main reasons for using PR is to control disruptive or &#8220;uncooperative&#8221; behavior on the part of the patient&#46; However&#44; these studies offer no in-depth analysis of the possible causes of such behavior&#44; e&#46;g&#46;&#44; pain or delirium&#44; and simply label all these manifestations as corresponding to an &#8220;agitated patient&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> This lack of analysis may be a consequence of failure to recognize the use of PR as a multifactorial and highly complex phenomenon&#46; In this respect&#44; qualitative studies published in recent years offer an in-depth exploration of the opinions and beliefs regarding the factors both against and in favor of the use of PR&#44; particularly the prevention and management of pain&#44; agitation and delirium within the Units&#44; as influencing factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;12</span></a> These studies show PR to be a shared responsibility within the care team&#44; in which each professional plays a key role&#46; The most current theoretical models&#44; such as eCash&#44; coincide that the use of PR must be tied to patient wellbeing in the ICU&#44; and that the prevention&#44; monitoring and treatment &#40;whether pharmacological or otherwise&#41; of pain&#44; agitation and delirium&#44; such as multimodal analgesia&#44; dexmedetomidine&#44; early mobilization&#44; respect for sleep&#44; and family accompaniment&#44; are interdisciplinary issues that require joint effort&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another frequent claim is the need to relate work load and the nurse-to-patient ratio to the use of PR&#46; However&#44; this argument likewise does not appear to stand up to the evidence&#44; since the use of PR remains common in Units with a ratio of 1&#58;1&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> and although it is true that the ratios should be adjusted to the work load&#44; this solution nowadays is neither realistic nor feasible&#46; What does seem clear is that continuous vigilance and accompaniment at the patient bedside would contribute to avoid the need for PR&#46; In this regard a fundamental requirement is the commitment of organizations to policies of change designed to promote accompaniment by the family and shared and reflective decision making by all the members of the team&#46; The approach to minimizing PR in the ICU should be a multicomponent initiative adapted to each organization and focused on the reality of each center&#44; with the purpose of creating a new &#8220;culture of care&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The proposals made by both the Analgesia&#44; Sedation&#44; Restraint and Delirium Working Group of the Spanish Society of Nursing in Intensive Care and Coronary Units &#40;<span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias</span> &#91;SEEIUC&#93;&#41; and the Sedation&#44; Analgesia and Delirium Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units &#40;<span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias</span> &#91;SEMICYUC&#93;&#41; comprise a joint approach to these problems&#44; integrating the use of PR with aspects related to pain&#44; agitation and delirium&#44; and advocate an interdisciplinary perspective&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> In this regard&#44; the &#8220;do not do&#8221; recommendations of the Sedation&#44; Analgesia and Delirium Working Group of the SEMICYUC specifically contemplate the avoidance of PR as a delirium preventive measure&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Likewise&#44; the Analgesia&#44; Sedation&#44; Restraint and Delirium Working Group is obtaining real data from multicenter studies in our setting on the management of pain&#44; agitation and delirium&#44; factors related to the use of PR and patient self-removal of devices&#44; and information referred to the suitability of use of PR &#40;prescription&#44; registry&#44; written informed consent&#44; duration of the measure&#44; etc&#46;&#41; in order to allow comparisons to be made in our context&#44; as well as to establish cautious extrapolations referred to the international setting&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">It seems that the challenge of reflection and progress toward PR-free critical care has finally been accepted&#46; However&#44; in order for such progress to be adequate&#44; we need to acknowledge our reality and difficulties&#44; open our perspective and ask research questions referred to more reflective and inclusive strategies&#44; with innovative and interdisciplinary initiatives in which institutional implication is also present&#46; Only in this way can we advance from the current position on the adequate management of PR as a pending and emerging matter in the ICU&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-25"
    "fechaAceptado" => "2018-09-04"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Acevedo-Nuevo M&#44; Via-Clavero G&#44; en nombre del Grupo de Trabajo Analgesia&#44; Sedaci&#243;n&#44; Contenciones y Delirio de la Sociedad Espa&#241;ola de Enfermer&#237;a Intensiva y Unidades Coronarias&#46; La reducci&#243;n del uso de contenciones mec&#225;nicas&#44; una asignatura pendiente y emergente en las UCI&#46; Med Intensiva&#46; 2019&#59;43&#58;299&#8211;301&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1754
            "Ancho" => 2500
            "Tamanyo" => 265656
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reflective model on the use of physical restraint measures&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">PAD&#58; pain&#47;agitation&#47;delirium&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adapted from Via-Clavero et al&#46; Ethical-legal and clinical considerations on the use of restraining measures&#46; Official College of Nurses of Barcelona &#40;<span class="elsevierStyleItalic">Col&#183;legi Oficial d&#8217;Infermeres i Infermers de Barcelona</span> &#91;COIB&#93;&#41;&#46; Pending publication&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; risk factors&#44; and outcomes associated with physical restraint use in mechanically ventilated adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Rose"
                            1 => "L&#46; Burry"
                            2 => "R&#46; Mallick"
                            3 => "E&#46; Luk"
                            4 => "D&#46; Cook"
                            5 => "D&#46; Fergusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2015.09.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "31"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26489482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit&#58; Use of restraining therapies &#8211; American College of Critical Care Medicine Task Force 2001&#8211;2002"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;A&#46; Maccioli"
                            1 => "T&#46; Dorman"
                            2 => "B&#46;R&#46; Brown"
                            3 => "J&#46;E&#46; Mazuski"
                            4 => "B&#46;A&#46; McLean"
                            5 => "J&#46;M&#46; Kuszaj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000095463.72353.AD"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "2665"
                        "paginaFinal" => "2676"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical restraint&#58; time to let go"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Burry"
                            1 => "L&#46; Rose"
                            2 => "B&#46; Ricou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2018"
                        "volumen" => "44"
                        "paginaInicial" => "1296"
                        "paginaFinal" => "1298"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical Practice Guidelines for the prevention and management of pain&#44; agitation&#47;sedation&#44; delirium&#44; immobility&#44; and sleep disruption in adult patients in the ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;W&#46; Devlin"
                            1 => "Y&#46; Skrobik"
                            2 => "C&#46; G&#233;linas"
                            3 => "D&#46;M&#46; Needham"
                            4 => "A&#46;J&#46;C&#46; Slooter"
                            5 => "P&#46;P&#46; Pandharipande"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2018"
                        "volumen" => "46"
                        "paginaInicial" => "e825"
                        "paginaFinal" => "e873"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical restraint use in intensive care units across Europe&#58; the PRICE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Benbenbishty"
                            1 => "S&#46; Adam"
                            2 => "R&#46; Endacott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Intensive Crit Care Nurs"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "241"
                        "paginaFinal" => "245"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contenci&#243;n mec&#225;nica&#58; su uso en cuidados intensivos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Mart&#237;n Iglesias"
                            1 => "C&#46; Pont&#243;n Soriano"
                            2 => "M&#46;T&#46; Quinti&#225;n Guerra"
                            3 => "T&#46;R&#46; Velasco Sanz"
                            4 => "M&#46;R&#46; Merino Mart&#237;nez"
                            5 => "M&#46;J&#46; Sim&#243;n Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.enfi.2012.08.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "164"
                        "paginaFinal" => "170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23041321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Restricciones f&#237;sicas en UCI&#44; su utilizaci&#243;n y percepci&#243;n de pacientes y familiares"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;I&#46; P&#233;rez de Ciriza Amatriain"
                            1 => "A&#46; Nicol&#225;s Olmedo"
                            2 => "R&#46; Go&#241;i Viguria"
                            3 => "E&#46; Regaira Mart&#237;nez"
                            4 => "M&#46;A&#46; Margall Coscojuela"
                            5 => "M&#46;C&#46; Asiain Erro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "77"
                        "paginaFinal" => "86"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with unplanned extubation in the Intensive Care Unit for adult patients&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Z&#46;P&#46; Ai"
                            1 => "X&#46;L&#46; Gao"
                            2 => "X&#46;L&#46; Zhao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.iccn.2018.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Crit Care Nurs"
                        "fecha" => "2018"
                        "volumen" => "47"
                        "paginaInicial" => "62"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29653888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence&#44; risk factors&#44; and outcomes of delirium in mechanically ventilated adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Mehta"
                            1 => "D&#46; Cook"
                            2 => "J&#46;W&#46; Devlin"
                            3 => "Y&#46; Skrobik"
                            4 => "M&#46; Meade"
                            5 => "D&#46; Fergusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "557"
                        "paginaFinal" => "566"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient agitation and its management in adult critical care&#58; a systematic review and narrative synthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Freeman"
                            1 => "J&#46; Yorke"
                            2 => "P&#46; Dark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jocn.14258"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Nurs"
                        "fecha" => "2018"
                        "volumen" => "27"
                        "paginaInicial" => "e1284"
                        "paginaFinal" => "e1308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29314320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manejo de la inmovilizaci&#243;n terap&#233;utica en Unidades de Cuidados Cr&#237;ticos&#58; aproximaci&#243;n fenomenol&#243;gica a la realidad enfermera"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Acevedo-Nuevo"
                            1 => "M&#46;T&#46; Gonz&#225;lez-Gil"
                            2 => "M&#46; Sol&#237;s-Mu&#241;oz"
                            3 => "N&#46; L&#225;iz-D&#237;ez"
                            4 => "M&#46;J&#46; Tora&#241;o-Olivera"
                            5 => "L&#46;F&#46; Carrasco-Rodr&#237;guez-Rey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.enfi.2015.11.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Enferm Intensiva"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "62"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26805701"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eliciting critical care nurses&#8217; beliefs regarding physical restraint use"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Via-Clavero"
                            1 => "M&#46; Sanju&#225;n-Nav&#225;is"
                            2 => "M&#46; Romero-Garc&#237;a"
                            3 => "L&#46; de la Cueva-Ariza"
                            4 => "G&#46; Mart&#237;nez-Estalella"
                            5 => "E&#46; Plata-Menchaca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0969733017752547"
                      "Revista" => array:2 [
                        "tituloSerie" => "Nurs Ethics"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comfort and patient-centred care without excessive sedation&#58; the eCASH concept"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Vincent"
                            1 => "Y&#46; Shehabi"
                            2 => "T&#46;S&#46; Walsh"
                            3 => "P&#46;P&#46; Pandharipande"
                            4 => "J&#46;A&#46; Ball"
                            5 => "P&#46; Spronk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-016-4297-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "962"
                        "paginaFinal" => "971"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27075762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones para el tratamiento de los pacientes cr&#237;ticos de los Grupos de Trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Hern&#225;ndez-Tejedor"
                            1 => "O&#46; Pe&#241;uelas"
                            2 => "G&#46; Sirgo-Rodr&#237;guez"
                            3 => "J&#46; Llompart-Pou"
                            4 => "E&#46; Palencia-Herrej&#243;n"
                            5 => "A&#46; Estella"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2017.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2017"
                        "volumen" => "41"
                        "paginaInicial" => "285"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28476212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones de &#171;no hacer&#187; en el tratamiento de los pacientes cr&#237;ticos de los grupos de trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Gonz&#225;lez de Molina Ortiz"
                            1 => "F&#46; Gordo Vidal"
                            2 => "A&#46; Estella Garc&#237;a"
                            3 => "P&#46; Morrondo Valdeolmillos"
                            4 => "J&#46;F&#46; Fern&#225;ndez Ortega"
                            5 => "J&#46; Caballero L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2018.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2018"
                        "volumen" => "42"
                        "paginaInicial" => "425"
                        "paginaFinal" => "443"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29789183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004300000005/v1_201906010831/S2173572719300906/v1_201906010831/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "402"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Point of view"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000005/v1_201906010831/S2173572719300906/v1_201906010831/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300906?idApp=WMIE"
]
Article information
ISSN: 21735727
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 16 15 31
2024 October 72 40 112
2024 September 83 25 108
2024 August 72 35 107
2024 July 94 28 122
2024 June 80 37 117
2024 May 63 29 92
2024 April 76 34 110
2024 March 82 23 105
2024 February 97 38 135
2024 January 88 29 117
2023 December 93 35 128
2023 November 119 54 173
2023 October 130 31 161
2023 September 88 40 128
2023 August 82 19 101
2023 July 123 24 147
2023 June 91 21 112
2023 May 98 45 143
2023 April 85 18 103
2023 March 112 34 146
2023 February 105 48 153
2023 January 93 20 113
2022 December 97 40 137
2022 November 112 39 151
2022 October 107 48 155
2022 September 93 49 142
2022 August 96 44 140
2022 July 60 47 107
2022 June 65 41 106
2022 May 59 38 97
2022 April 69 81 150
2022 March 78 83 161
2022 February 79 46 125
2022 January 95 35 130
2021 December 91 69 160
2021 November 74 32 106
2021 October 99 82 181
2021 September 53 57 110
2021 August 79 44 123
2021 July 51 34 85
2021 June 63 38 101
2021 May 96 63 159
2021 April 215 108 323
2021 March 168 33 201
2021 February 119 32 151
2021 January 81 39 120
2020 December 87 23 110
2020 November 70 31 101
2020 October 70 28 98
2020 September 64 19 83
2020 August 36 25 61
2020 July 51 33 84
2020 June 34 20 54
2020 May 48 19 67
2020 April 58 27 85
2020 March 25 23 48
2020 February 102 65 167
2020 January 39 16 55
2019 December 54 24 78
2019 November 38 26 64
2019 October 9 4 13
2019 September 0 0 0
2019 May 0 2 2
Show all

Follow this link to access the full text of the article

Idiomas
Medicina Intensiva (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?