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Physical Restraint in Mechanically Ventilated ICU Patients

Physical Restraint in Mechanically Ventilated ICU Patients

The Chair of the Editorial and Publications Committee, and Editor of Intensive Care Medicine journal has selected the article "Physical Restraint in Mechanically Ventilated ICU Patients: A Survey of French Practice" as one of the "Articles of the Month" for January 2013.

The corresponding author of the article, Bernard De Jonghe summarised the following Clinical Implications of the article on the results of this French survey. He writes:

This nationwide practice survey conducted in a country with a high patient-to-nurse ratio showed a high rate of physical restraint (PR) use, both in terms of percentage of patients receiving mechanical ventilation and percentage of time spent on the ventilator.

Wide variations according to patient condition were reported. Of interest, almost 30% of ICUs report PR use in more than 50% of awake, calm and co-operative patients, a frequent situation among ICU patients in an era of lighter sedation. This high rate reflects the reluctance to expose patients to self-removal of potentially live saving devices but also exposes conscious patients to a potentially uncomfortable and degrading measure. Our finding that PR is usually started and removed without written medical orders indicates that use of PR is mainly based on the nurses’ initiative and practical judgment.

PR use could be improved by increasing consideration among ICU physicians of PR as a full-fledged aspect of patient management, requiring written medical orders to start and remove PR, and extending presence of family and relatives. The variations in PR use according to patient condition shown in the present survey could serve as a reasonable basis for developing and implementing PR use policies on a local or national scale. Such policies could also contribute to shift the burden of responsibility from nurses to the entire ICU team.

PHOTO: Author Dr Bernard De Jonghe

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