Skip to main content

Factors influencing the use of physical restraints in Canadian ICUs


Physical restraint (PR) use in critically ill patients has been associated with delirium, unplanned extubation, prolonged ICU length of stay, and post-traumatic stress disorder. Our objectives were to define prevalence of PR use, and to examine patient, treatment, or institutional factors associated with their use in Canadian ICUs.


We conducted an analysis of a database of sedative, analgesic, antipsychotic and neuromuscular blocker prescribing practices and PR use in 711 mechanically ventilated (MV) adults in 51 Canadian ICUs (3,619 patient-days). Data were collected during a 2-week period (2008 to 2009). Logistic and Poisson regression analysis were used to identify factors associated with PR use and number of days of use respectively.


PR was used on 1 or more days in 52.6% (374/711) of patients. For patients restrained, the mean number of days restrained was 4.1 ± 4.0 and the mean number of restraint applications per patient was 1.2 ± 0.5. Treatment characteristics associated with PR use were: daily benzodiazepine dose (OR = 1.01, 95% CI: 1.00 to 1.01), daily opiate dose (OR = 1.00, 95% CI: 1.00 to 1.01), daily sedation interruption (OR = 1.84, 95% CI: 1.24 to 2.72), use of antipsychotics (OR = 3.42, 95% CI: 1.98 to 5.91) and agitation (Sedation-Agitation Scale (SAS) >4, OR = 2.55, 95% CI: 1.20 to 5.44). Additionally, number of days of PR use was increased according to the following: daily sedation interruption (IRR = 4.52, 95% CI: 2.09 to 9.75), use of antipsychotics (IRR = 18.65, 95% CI: 7.95 to 43.77), the presence of a heavily sedated score (SAS <3, IRR = 2.57, 95% CI: 1.06 to 6.24) or the presence of an adverse event, such as selfextubation (IRR = 10.46, 95% CI: 2.55 to 42.92). Hospital characteristics associated with PR use included the proportion of MV patients in the ICU. University hospitals were associated with reduced PR use, compared with community hospitals (OR = 0.272, 95% CI: 0.15 to 0.50). Nonmodifiable patient characteristics (age, sex, APACHE score, patient category, prior substance abuse, prior psychotropic medication, preexisting psychiatric condition or dementia) were not associated with PR use.


We identified multiple factors associated with PR use and number of days of PR use. Particularly among those related to treatment, strategies such as daily sedation interruption or use of antipsychotics are associated with PR use and increasing the number of days of use.

Author information



Corresponding author

Correspondence to B Sneyers.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Sneyers, B., Luk, E., Perreault, M. et al. Factors influencing the use of physical restraints in Canadian ICUs. Crit Care 17, P394 (2013).

Download citation


  • Physical Restraint
  • Hospital Characteristic
  • Prior Substance
  • Poisson Regression Analysis
  • Unplanned Extubation