Physical Restraint Practices in Critical Care Settings

Physical restraints remain a common intervention in intensive and critical care units worldwide, employed to prevent accidental removal of life-support devices, reduce falls, and manage severe agitation. Practices vary considerably between regions and institutions, with reported usage rates ranging from around 25% to over 50% of mechanically ventilated patients. Decisions to apply restraints are influenced primarily by treatment characteristics such as sedation regimen intensity, use of antipsychotic agents and continuous rather than intermittent sedation, as well as by episodes of delirium or high agitation scores. While restraints may reduce the immediate risk of device dislodgement, they carry potential physical harms—pressure injuries, impaired mobility—and psychological consequences including heightened anxiety or post-traumatic stress. Ethical and legal concerns centre on patient autonomy and the balance of duty of care against freedom of movement. Recent guidelines stress restraint minimisation, advocating for regular assessment, documentation and evaluation of necessity, and exploration of alternative approaches such as enhanced nursing observation, environmental modifications and tailored sedation protocols. Interprofessional education, clear institutional policies and family engagement have emerged as key components in promoting safe, least-restrictive care and harmonising practice across critical care settings.

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Physical Restraint Practices in Critical Care Settings publication trend

The graph below shows the total number of articles in physical restraint practices in critical care settings across all publications each year (not limited to Nature Index journals).

Technical terms

Physical restraint: Any manual method or device that restricts a patient’s freedom of movement.

Mechanical restraint: Use of fixed or adjustable devices (e.g. belts, bedrails) to limit patient movement.

Sedation-analgesia: Combined use of sedative and pain-relieving medications to manage patient discomfort and agitation.

Self-extubation: Unplanned removal of an endotracheal tube by the patient, often with serious clinical consequences.

Agitation: A state of restlessness or heightened motor activity, commonly assessed by validated scales to guide intervention.

References

1. Predicting Critical Care Nurses’ Intention to Use Physical Restraints in Intubated Patients: A Structural Equation Model. Journal of Nursing Management (2023).
2. Predictors of physical restraint use in Canadian intensive care units. Critical Care (2014).
3. Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. International Journal of Nursing Studies (2020).