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Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
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Physical Restraint-related Skin Injuries Among Patients in Intensive Care: A Prospective Cohort Study.

Yeter Özdemir1, Yasemin Uslu2

  • 1Sisli Hamidiye Eftal Education and Research Hospital, Istanbul, Turkey.

Advances in Skin & Wound Care
|January 20, 2026
PubMed
Summary

Physical restraint use in intensive care units (ICUs) can cause skin injuries like edema and pressure injuries. Male sex, obesity, and prolonged restraint duration are key risk factors for these injuries.

Keywords:
intensive care unitnursing carepatient safetyphysical restraintspressure injuryskin injury

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Area of Science:

  • Critical Care Medicine
  • Patient Safety
  • Dermatology

Background:

  • Physical restraints are frequently used in intensive care units (ICUs) to manage patient behavior.
  • Skin injuries are a common complication associated with physical restraint use in critically ill patients.
  • Identifying risk factors is crucial for preventing restraint-related adverse events.

Purpose of the Study:

  • To determine the incidence of skin injuries in physically restrained ICU patients.
  • To identify risk factors associated with the development of physical restraint-related skin injuries.

Main Methods:

  • A prospective cohort study was conducted in 5 ICUs, involving 260 physically restrained patients.
  • Data on skin injuries were collected using standardized forms, including the Physical Restraint Monitoring Form and Skin Injury Assessment Guide.
  • Statistical analysis identified risk factors for pressure injuries.

Main Results:

  • The most frequent injuries were edema (71.9%), ecchymosis (52.3%), scaling (30.8%), and pressure injuries (20%).
  • Pressure injuries were more prevalent in neurosurgery and anesthesia/reanimation ICUs.
  • Independent risk factors for pressure injuries included male sex, overweight/obesity, and restraint duration of 46 hours or more.

Conclusions:

  • Skin injuries in critically ill patients under physical restraint are influenced by patient demographics, body mass index, restraint duration, and materials used.
  • Implementing evidence-based guidelines and consistent monitoring are essential for mitigating risks and enhancing patient safety.