Physical Restraint Use in Adult Intensive Care Units (ICUs): A Systematic Review

Thumbnail Image



Journal Title

Journal ISSN

Volume Title


The Ohio State University

Research Projects

Organizational Units

Journal Issue


Problem: Critically ill adults are at high risk for developing anxiety, agitation, delirium, and weakness during their ICU stay. The role physical restraints (PR) play in the development and outcomes of these symptoms has yet to be determined. Purpose: The purpose of this systematic review of the literature was to critically evaluate the prevalence, predictors, and outcomes of PR use in adult ICUs. Search Strategy: We searched eight computerized databases through September 2015. All studies and quality improvement projects that included the terms physical restraints, ICU, and/or critical care in their title and/or abstract were considered eligible for inclusion. Studies conducted outside the ICU, including pediatric patients, case reports, and prior reviews, were excluded. Results of Literature Search: A total of 307 studies were screened, 41 (13%) met inclusion criteria and underwent independent, standardized data abstraction by 2 reviewers. The majority of studies were conducted outside the U.S (23/41, 56%) in diverse ICU types. Study design varied, with most being prospective (34/41, 83%), observational and/or descriptive studies that included the use of surveys and/or interviews (22/41, 55%). Synthesis of Evidence: Actual (vs. perceived) prevalence of PR use was reported in 23/41 studies. Global prevalence rates varied widely (0-87%), with 0% PR use observed in the UK, Portugal, and Norway and 20-87% (N=6) in the US. Factors significantly associated with PR were reported in 22/41 studies and included: level of arousal, delirium, higher RN to patient ratio/nurse workload, use of tubes/catheters, medications (i.e., benzodiazepines, opioids, antipsychotics, anticholinergics, and antidepressants) diagnosis/unit type, age, smoking/alcohol/psychiatric history, mechanical ventilation use, and infections. Few studies (13/41) evaluated the effect of PR on clinical outcomes. These studies found PR use was significantly associated with delirium, unplanned or self- extubation, injuries including self-device removal and PR complications, agitation, longer ICU LOS, and reintubation. Implications for Practice: While providers often use PR to protect patients from harm, evidence suggests their application is associated with substantial iatrogenic injury. Prospective randomized controlled trials are needed to further examine the safety and effectiveness of PR use in the ICU setting.


Midwest Nursing Research Society - Student Poster BSN Category - Honorable Mention


physical restraint, physical restraints, intensive care unit, ICU