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British Journal of Anaesthesia, 2004, Vol. 92, No. 6 789-792
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial IV

Physical and pharmacological restraint of critically ill patients: clinical facts and ethical considerations

M. Nirmalan*,1, P. M. Dark2, P. Nightingale3 and J. Harris4

1 Manchester Royal Infirmary, Manchester, UK 2 Hope Hospital Salford, Salford, UK 3 South Manchester University Hospitals, Manchester, UK 4 School of Law, University of Manchester, Manchester, UK

*Corresponding author: E-mail: m.nirmalan@man.ac.uk

The first 150 words of the full text of this article appear below.

Agitation or delirium on withdrawal of sedation is a frequent problem in the ICU with a reported prevalence of 15–40%.1 2 The incidence is likely to increase further as critical care becomes more comprehensive, enabling increasing numbers of elderly and more severely ill patients to gain admission. The consequences of agitation in the ICU are potentially life-threatening as a result of self-extubation or removal of vital catheters, drains and other invasive monitoring devices. The importance of agitation in the critical care setting was highlighted at a recent international multidisciplinary expert panel meeting2 where its aetiology, pathophysiology and therapeutics were considered in detail. The participants, however, steered clear of some of the difficult ethical issues including those related to the use of physical restraints.

Physical restraint of patients is considered unacceptable in the UK as it is frequently associated with ‘imprisonment’ or with the sorts of restraints seen in prisoners. Dr Philippe . . . [Full Text of this Article]

Causes of agitation in the ICU

Consequences of prolonged ICU stay

Physical restraints in the ICU

Ethics of restraint

Nature of the respective methods
Consequences for the patient
Consequences for third parties

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