{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:43:34Z","timestamp":1787669014192,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,7,14]],"date-time":"2024-07-14T00:00:00Z","timestamp":1720915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post\u2010traumatic stress disorder (PTSD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800\u2010bed secondary medical centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>This retrospective study included 647 patients admitted to a general ICU in an 800\u2010bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28\u2010day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti\u2010psychotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti\u2010psychotics. Patients who were restrained had longer duration of ventilation (5.9\u2009\u00b1\u20098.2 vs. 0.36\u2009\u00b1\u20091.4\u2009days; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and higher 28\u2010day mortality (0.26\u2009\u00b1\u20090.45 vs. 0.07\u2009\u00b1\u20090.25, <jats:italic>Z<\/jats:italic>\u2009=\u20096.86, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; <jats:italic>p<\/jats:italic>\u2009=\u2009.019), as well as the use of anti\u2010psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; <jats:italic>p<\/jats:italic>\u2009=\u2009.034) and anti\u2010depressants (55 [21.2%] vs. 59 [14.8%], respectively; <jats:italic>p<\/jats:italic>\u2009=\u2009.042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001); higher frequency of in\u2010hospital anti\u2010psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7\u2009\u00b1\u20094.0 vs. 0.04\u2009\u00b1\u20090.27, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001] and maximum RASS score [0.19\u2009\u00b1\u20091.6 vs. 0.01\u2009\u00b1\u20090.54, respectively; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28\u2010day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in\u2010hospital anti\u2010psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Relevance to Clinical Practice<\/jats:title><jats:p>Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU. <jats:italic>Clinical trial registration<\/jats:italic>: NCT04771793.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nicc.13130","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T05:11:50Z","timestamp":1721020310000},"page":"1132-1141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Physical restraint and associated agitation"],"prefix":"10.1111","volume":"29","author":[{"given":"Shimon","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler School of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-770X","authenticated-orcid":false,"given":"Avraham","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler School of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisim","family":"Ifrach","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler School of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Dichtwald","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Medicine Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler School of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182211826"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2010.08.003"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010012\u20102715\u20109"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100372\u20108"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000164540.58515.BF"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010007\u20100600\u20108"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202006\u2010738OC"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246\u2010199806000\u201000008"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)62072\u20109"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3143\/geriatrics.56.283"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1590\/s1980\u2010220x2018058503571"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm\u201020\u2010563"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.4102\/curationis.v39i1.1605"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc13789"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15052"},{"issue":"10","key":"e_1_2_11_17_1","article-title":"Non\u2010pharmacological interventions for sleep promotion in the intensive care unit","volume":"6","author":"Rong\u2010Fang H","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2107138"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.13130","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T12:20:13Z","timestamp":1724934013000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.13130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,14]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1111\/nicc.13130"],"URL":"https:\/\/doi.org\/10.1111\/nicc.13130","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,14]]},"assertion":[{"value":"2023-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}