{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:19:47Z","timestamp":1793157587117,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,4,14]]},"abstract":"\n Importance<\/jats:title>\n The effect of wrist-strap physical restraints on outcomes in patients receiving mechanical ventilation in the intensive care unit (ICU) remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the effect of a low-use wrist-strap physical restraint strategy in critically ill patients receiving invasive mechanical ventilation.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Open-label randomized clinical trial conducted across 10 ICUs in France. Between January 5, 2021, and January 2, 2024, 405 adult patients who had initiated invasive mechanical ventilation within the previous 6 hours and were expected to require ventilation for at least 48 hours were enrolled. Follow-up was completed on May 17, 2024. Statistical analysis was conducted from June 1, 2025, to December 15, 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomized to undergo either a restrictive, low-use physical restraint strategy (wrist straps avoided unless necessary because of severe agitation, defined as a Richmond Agitation-Sedation Scale score of \u22653 [on a scale from \u22125 (unresponsive) to 4 (combative)]; n\u2009=\u2009201) or a liberal, high-use strategy (wrist straps applied systematically and reassessed daily; n\u2009=\u2009204). Discontinuation of restraints was allowed in patients who were awake or extubated without delirium (measured via the Confusion Assessment Method for the ICU).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the number of days alive without coma or delirium during the first 14 days after randomization. Secondary outcomes included incidence of self-extubation and day-90 mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 396 patients with available primary outcome data, the median (IQR) age was 65 (56-73) years, 245 (62%) were male, and the median (IQR) Sequential Organ Failure Assessment score was 7 (4-10). The mean days alive without coma or delirium were 6.67 days (95% CI, 5.69-7.65) in the low-use strategy group and 6.30 days (95% CI, 5.35-7.24) in the high-use strategy group (adjusted mean difference, 0.37 days [95% CI, \u22120.71 to 1.46];\n P<\/jats:italic>\n \u2009=\u2009.51). Self-extubation occurred in 18 patients (9.2%) in the low-use strategy group and 17 (8.5%) in the high-use strategy group, and day-90 mortality was 37.2% and 41.0%, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial, among adult patients receiving mechanical ventilation in the ICU, a low-use wrist-strap physical restraint strategy compared with a high-use strategy did not reduce days free of delirium or coma at 14 days.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04273360<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.2897","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:16:49Z","timestamp":1773767809000},"page":"1232","source":"Crossref","is-referenced-by-count":12,"title":["Restrictive vs Liberal Physical Restraint Strategies in Critically Ill Patients"],"prefix":"10.1001","volume":"335","author":[{"given":"Romain","family":"Sonneville","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, IAME, INSERM UMR 1137, Paris, France"},{"name":"AP-HP.Nord, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, DMU INVICTUS, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Couffignal","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, IAME, INSERM UMR 1137, Paris, France"},{"name":"AP-HP.Nord, Epidemiology, Biostatistics, and Clinical Research, Bichat-Claude Bernard University Hospital, DMU PRISME, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Sigaud","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Grenoble Alpes University Hospital, La Tronche, 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