With respect to the article by Chang and colleagues1 in the September 2008 issue, I applaud the authors for attempting to address the difficult issue of preventing unplanned extubations in the intensive care unit (ICU). However, I believe that additional information was required to support the authors’ conclusion that the application of physical restraint is on its own a risk factor for self-extubation.

The authors provide little information about the decision-making process for application of restraint in the study ICU. They do state that an “evaluation of the risk of unplanned extubation and/or fall”1 (p410) was performed, but they provide no details of the content of this evaluation or of the potential differences in risk category among the patient groups that it might reveal. Did the patients who were included in the unplanned extubation group score at higher risk than those...

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