Physical restraint in mechanically ventilated ICU patients: a survey of French practice.
OBJECTIVE
To characterize the perceived utilization of physical restraint (PR) in mechanically ventilated intensive care unit (ICU) patients and to identify clinical and structural factors influencing PR use.


METHODS
A questionnaire was personally handed to one intensivist in 130 ICUs in France then collected on-site 2 weeks later.


RESULTS
The questionnaire was returned by 121 ICUs (response rate, 93 %), 66 % of which were medical-surgical ICUs. Median patient-to-nurse ratio was 2.8 (2.5-3.0). In 82 % of ICUs, PR is used at least once during mechanical ventilation in more than 50 % of patients. In 65 % of ICUs, PR, when used, is applied for more than 50 % of mechanical ventilation duration. Physical restraint is often used during awakening from sedation and when agitation occurs and is less commonly used in patients receiving deep sedation or neuromuscular blockers or having severe tetraparesis. In 29 % of ICUs, PR is used in more than 50 % of awake, calm and co-operative patients. PR is started without written medical order in more than 50 % of patients in 68 % of ICUs, and removed without written medical order in more than 50 % of patients in 77 % of ICUs. Only 21 % of ICUs have a written local procedure for PR use.


CONCLUSIONS
This survey in a country with a relatively high patient-to-nurse ratio shows that PR is frequently used in patients receiving mechanical ventilation, with wide variations according to patient condition. The common absence of medical orders for starting or removing PR indicates that these decisions are mostly made by the nurses.
Réanimation Médico-Chirurgicale, Centre Hospitalier de Poissy, 10 rue du Champ Gaillard, 78300, Poissy, France. bdejonghe@chi-poissy-st-germain.fr
Bernard
B
De Jonghe
Jean-Michel
JM
Constantin
Gerald
G
Chanques
Xavier
X
Capdevila
Jean-Yves
JY
Lefrant
Hervé
H
Outin
Jean
J
Mantz
D006801:Humans; D007362:Intensive Care Units; D024802:Nurse's Role; D012121:Respiration, Artificial; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires