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Response

My colleagues and I appreciate these comments about our work. As Ms Dunn notes, unplanned extubation (UE) is a concern for all clinicians working in intensive care. Factors related to the development of UE are quite numerous, however. Our study¹ was aimed at identifying the most essential factors in order to support clinical decision making related to the use of physical restraints. We did investigate the contribution of physical restraints in the UE compared with a no-UE group (data are shown in Table 2, p 412), but we also identified the contributing factors of UE in patients who had physical restraints versus those who had no physical restraints (Table 3, p 413). These data indicate that the contributing factors for UE were different in the 2 groups (physical restraints vs no physical restraints).

The physical restraints protocol in our study was governed by the ethical review board of the medical center; every restraint event was documented with evidence to meet the criteria of the regulation. The only physical restraint used in the study unit was wrist restraint. We used a case-control design and the data were limited by what was available in the medical records. A prospective study might provide more powerful conclusions. We therefore encourage more studies on this topic to help inform clinical decision making.

doi: 10.4037/ajcc2009491

FINANCIAL DISCLOSURES
None reported.

REFERENCE

1. Chang L-Y, Wang K-WK, Chao Y-F. Influence of physical restraint on unplanned extubation of adult intensive care patients: a case-control study. Am J Crit Care. 2008;17(5):408–416.[Abstract/Free Full Text]

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