title: Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: contributing factors.
abstract: Chemical and physical restraints are frequently used in the intensive care unit (ICU) to control agitated patients and to prevent self-harm and unplanned extubations. Published work relating to the numerous issues of the care and treatment strategies for these patients remains conflicting and unclear. Literature regarding sedation and chemical restraint reveals a trend towards management with lighter sedation, use of sedation assessment tools and sedation protocols. It remains unclear which treatment is best for agitated and delirious patients, and the evidence on the effect of sedation is conflicting. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. The purpose of this paper is to provide a summary of the existing literature on the use of physical and chemical restraints in the ICU setting. In Part 1 of this two-part paper, the evidence on chemical and physical restraints is explored with specific focus on definition of terms, unplanned extubation, agitation, delirium and the impact of nurse-patient ratios in the ICU on these issues. Part 2 of the paper examines the evidence related to chemical and physical restraints from the perspective of the mechanically ventilated patient.
authors.affiliation: Departement of Anaestesiology and Intensive Care Medicine, Rikshospitalet-Medical Centre, Sognsvannsveien 20, 0027 Oslo, Norway. kristin.hofso@rikshospitalet.no
authors.forename: Kristin
authors.initials: K
authors.lastname: Hofsø
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Coyer
mesh_terms: D001291:Attitude of Health Personnel; D015400:Clinical Nursing Research; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods / Q000451:nursing*; D003422:Critical Care / Q000458:organization & administration*; D003693:Delirium / Q000517:prevention & control; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D018579:Patient Selection; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods / Q000451:nursing*; D012149:Restraint, Physical / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D016526:Workload