Physical restraint in the intensive care units: a narrative review of current practices and outcomes

Physical restraint remains common in the intensive care unit (ICU), but it is increasingly questioned following recent high‑quality evidence, particularly the R2D2‑ICU trial, which challenges the assumption that reducing restraint inherently improves short‑term neurological outcomes.

Epidemiological data reveal significant variability in the prevalence of restraint use, which is influenced by a complex interplay of patient characteristics, caregiver factors, and systemic elements. The evidence on its effectiveness for mainly preventing the pulling out of tubes is questionable. However, its association with a range of negative physical, neurological, and psychological outcomes. It also imposes a heavy burden of moral distress on caregivers, who are tasked with balancing patient safety against the imperative to minimize harm. Successful minimization of restraint use requires multicomponent approaches.

Moving toward restraint minimization requires a paradigm shift from viewing physical restraint as a standard safety tool to recognizing it as a potentially harmful intervention of last resort. Future evaluations should adopt the triadic outcomes framework outlined here, assessing neurological and psychological outcomes, family satisfaction, and caregiver moral burden to guide ethically sound, sustainable ICU practice.