Physical restraint: time to let go

Excerpt

Physical restraint, defined as any physical or mechanical device, material, or equipment immobilizing or obstructing a person’s ability to move freely [1], includes 2-point or 4-point wrist or leg restraints, waist or chest restraints, and mittens. Although the international prevalence of physical restraint in the intensive care unit (ICU) setting is highly variable [2], in some countries use is ubiquitous, particularly for mechanically ventilated patients. For example, in a survey of physicians representing 121 ICUs in France, 82% reported more than 50% of mechanically ventilated patients were restrained at least once [3]. In Canada, a period prevalence survey found 53% of 711 mechanically ventilated patients were physically restrained for an average of 4 days [4]. Unfortunately, variation in reporting of physical restraint incidence or prevalence (e.g., proportion of patients, % days, number of restraint orders/patient days) makes comparison of available data problematic. More work is required to standardize reporting that will enable better insight into true rates of physical restraint, particularly in the era of lighter sedation and early mobilization. …