Tie your mother down?

Excerpt

The album “A Day at the Races” contains a song written by Brian May in 1976 entitled “Tie Your Mother Down” which contains the words “Tie your mother down, or you ain’t no friend of mine.” This quote seems apt when the image of an agitated and delirious ventilated patient in the intensive care unit (ICU) comes to mind. In this issue of Intensive Care Medicine, de Jonghe et al. [1] describe the results of a survey addressing the perceived utilization of physical restraints (PR) in mechanically ventilated patients in France. The aim of their survey was to identify clinical and structural factors influencing the use of PR in this specific group of patients in the ICU. The authors are to be congratulated with their effort to investigate this important issue in daily critical care. Why are so many patients tied down, even though they seem to be perfectly at rest, or are even deeply comatose or even paralysed? These authors show that 29 % of the participating ICUs would appear to tie down 50 % of ICU patients despite these patients being in an awake, calm, and cooperative state; 81 % of participating centers would appear to adapt the tightness of the PR to the patient’s condition. Almost 80 % of participating ICUs stated that they do not believe that the use of PR in mechanically ventilated patients could be discontinued. Moreover, in only 56 % of the ICUs was the reason for using PR explained to the relatives, possibly leading to conflicts and disputes with the ICU team. This state of affairs seems hardly acceptable in an era where patients and their relatives play an increasingly important role in the recovery process from critical illness. However, in the centers surveyed, the median patient-to-nurse ratio was 2.8 (P ₂₅‐P ₇₅ = 2.5–3.0), which may well explain the PR policy in French ICUs. In other countries, this ratio may be 1.0 depending on local guidelines. Indeed, in a point prevalence study in 34 adult ICUs in nine European countries, the patient-to-nurse ratio, being on a ventilator, and the size of the ICU were all strongly related to PR use [2]. …