title: Physical restraint in the ICU: does it prevent device removal?
abstract: BACKGROUND
  Physical restraint is frequently used in the intensive care setting but little is known regarding its clinical scenario and effectiveness in preventing adverse events (AEs), defined as device removal.
  
  
  METHODS
  We carried out a prospective observational study in three Intensive Care Units on 120 adult high-risk patients. The effectiveness of physical restraint was evaluated using the propensity score methodology in order to obtain comparable groups.
  
  
  RESULTS
  Physical restraint was applied in 1371 of 3256 (43%) nurse shifts accounting for 120 patients. Substantial agitation, the nurse's judgement of insufficient sedation and sedative drug reduction were positively associated with physical restraint, whereas the presence of analgesics at admission, increased disease gravity and the treating hospital as the most substantial variable showed a negative association. Eighty-six AEs were observed in 44 patients. Quiet (SAS=1-4), unrestrained patients accounted for 40 cases, and agitated (SAS≥5) but physically restrained patients for 17 cases. The presence of any type of physical restraint had a protective effect against any type of AE (OR=0.28; CI 0.16-0.51). The observed AEs showed a limited impact on the patients' course of illness. No physical harm related to physical restraint was reported.
  
  
  CONCLUSIONS
  Physical restraint efficiently averts AEs. Its application is mainly driven by local habits. Typically, the almost recovered, apparently calm and hence unrestrained patient is at greatest risk for undesirable device removal. The control/interpretation of the patient's analgo-sedation might be inappropriate.
authors.affiliation: ICU, Ospedale Regionale Bellinzona e Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland - andreas.perren@eoc.ch.
authors.forename: A
authors.initials: A
authors.lastname: Perren
authors.forename: D
authors.initials: D
authors.lastname: Corbella
authors.forename: E
authors.initials: E
authors.lastname: Iapichino
authors.forename: V
authors.initials: V
authors.lastname: Di Bernardo
authors.forename: A
authors.initials: A
authors.lastname: Leonardi
authors.forename: R
authors.initials: R
authors.lastname: Di Nicolantonio
authors.forename: C
authors.initials: C
authors.lastname: Buschbeck
authors.forename: L
authors.initials: L
authors.lastname: Boegli
authors.forename: A
authors.initials: A
authors.lastname: Pagnamenta
authors.forename: R
authors.initials: R
authors.lastname: Malacrida
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000150:complications / Q000628:therapy; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000150:complications / Q000628:therapy; D012149:Restraint, Physical