Physical Restraint in Mechanically Ventilated ICU Patients: a French Practice Survey
Intensive Care Medicine
Bernard De Jonghe, MD
Réanimation Médico-Chirurgicale, Centre Hospitalier de Poissy, Poissy, France
Jean-Michel Constantin, MD, PhD
Réanimation Adulte, Département d’Anesthésie-Réanimation, CHU Hôtel-Dieu, ClermontFerrand, France
Gerald Chanques, MD, PhD
Département d’Anesthésie-Réanimation B, CHU Hôpital Saint-Eloi, Montpellier, France
Xavier Capdevilla, MD, PhD
Département d’Anesthésie-Réanimation A, CHU Hôpital Lapeyronie, Montpellier, France
Jean-Yves Lefrant, MD, PhD
Pôle d’Anesthésie-Réanimation-Urgences-Douleur, CHU Hôpital Carémeau, Nîmes, France
Hervé Outin, MD
Réanimation Médico-Chirurgicale, Centre Hospitalier de Poissy, Poissy, France
Jean Mantz, MD, PhD
Département d’Anesthésie-Réanimation SMUR, CHU Beaujon, APHP, Clichy, Paris-Diderot
University, Paris, France
And the Group “Interfaces Sédation”
Correspondence
Bernard De Jonghe
Réanimation Médico-Chirurgicale
Centre Hospitalier de Poissy
10 rue du Champ Gaillard,
78300 Poissy, France
Tel : +33 (0)1 39 27 52 03
Email : bdejonghe@chi-poissy-st-germain.fr
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Appendix. Questionnaire used in the study
Section 1. Characteristics of your ICU and hospital
Type of hospital
Public university hospital
Public non-university hospital
Private hospital
Other (please specify)
□
□
□
□______
Medical-surgical ICU
Medical ICU
Surgical ICU
Other (please specify)
□
□
□
□______
Type of ICU
ICU staff
Number of full-time physicians
Ratio number of ICU beds / number of full-time physicians,
__
_ _%
Proportion of physicians with intensive care medicine training
Proportion of physicians with anaesthesiology training
Proportion of physicians with emergency medicine training
Proportion of physicians with > 20 year experience in intensive care medicine
_ _%
_ _%
_ _%
_ _%
Proportion of physicians with 10 to 20 year experience in intensive care medicine
Proportion of physicians with 5 to 10 year experience in intensive care medicine
Proportion of physicians with < 5 year experience in intensive care medicine
_ _%
_ _%
_ _%
Usual patient-to-nurse ratio
_ _,_
ICU activity in 2009
Number of ICU beds
Number of ICU admissions
Proportion of surgical patients
Proportion of patients requiring MV, median (IQR)
Proportion of patients requiring MV > 48 hrs, median (IQR)
SAPS II score, median (IQR)
__
____
_ _%
_ _%
_ _%
__
Medical procedures in the ICU
Strict BGL control
Initial management of severe sepsis / septic shock
Weaning from mechanical ventilation
VAP prevention
yes / no
yes / no
yes / no
yes / no
Use of a sedation score
Use of a written sedation procedure
Daily interruption of sedation
yes / no
yes / no
yes / no
Sedation practices
MV, mechanical ventilation
BGL, blood glucose control
VAP, ventilator-associated pneumonia
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Section 2. Use of physical restraint in your ICU
In the following questions, the term « Physical restraint » refers to a mechanical restraint of the wrists. Any
discussion with one or more senior nurses in your ICU is encouraged.
1.
Overall, in your ICU, in what percentage of mechanically ventilated patients (invasive mechanical
ventilation) is PR used, at least once during the mechanical ventilation duration?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
2. In the following clinical conditions, in what percentage of mechanically ventilated patients is PR used ?
Patient under sedation and NMBs :
< 25 %
25-50 %
50-75 %
> 75%
Deeply sedated patient, without NMBs
Lightly sedated patient
Patient in awakening phase
Patient awake and agitated
Patient awake, calm, responding to orders ?
Patient awake with severe tetraparesis
Post-operative patient with abdominal or thoracic drainage
Patient with recent tracheotomy
3.
Overall, when PR is used, during what percentage of the mechanical ventilation duration is it used ?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
4.
When PR is used, is PR tightness adapted according to the patient’s condition?
Yes
No
5.
In what percentage of mechanically ventilated patients is PR (when used) started following a written
medical order?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
6.
In what percentage of mechanically ventilated patients is PR (when used) removed following a written
medical order?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
7.
Does your ICU have a written local procedure for PR use?
Yes
No
8.
In what percentage of patients is the reason for using PR (when used) explained to the patient’s relatives
(whoever -nurse, physician, resident, other- provides the explanation)?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
9.
In what percentage of patients is the reason for using PR (when used) explained to the patient after
awakening (whoever provides the explanation, i.e. either the nurse, the attending physician, the resident
or another staff member)?
< 25 %
25 – 50 %
50 – 75 %
> 75 %
10. Do you consider it would be achievable in your ICU to discontinue PR use in mechanically ventilated
patients?
Yes
No
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