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To Restrain or Not to RestrainA Teachable Moment

Educational Objective
To review current knowledge about best practices and challenges in the use of restraint in patients with delirium in the intensive care unit.
1 Credit CME

A man in his 80s with hypertension and type 2 diabetes was admitted to the intensive care unit (ICU) with acute hypoxic respiratory failure secondary to COVID-19. He experienced a protracted medical course requiring multiple intubations, complicated by ventilator-associated pneumonia and a pneumothorax necessitating chest tube placement. In total, he was intubated for 19 days.

While intubated, he frequently pulled at tubes and lines. Hospital staff had difficulty redirecting him and expressed concerns about reaching him quickly owing to respiratory isolation precautions. To address his ICU delirium, sedating medications were adjusted and adjunctive medications added. However, these changes were only moderately effective. The patient self-extubated and was reintubated on an emergency basis. Physical restraints were subsequently added.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Mary K. Finta, MD, Department of Internal Medicine, Michigan Medicine, 1500 E Medical Center Dr, 3116 Taubman Center, SPC 5368, Ann Arbor, MI 48109 (fintama@med.umich.edu).

Published Online: December 13, 2021. doi:10.1001/jamainternmed.2021.7165

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s wife for granting permission to publish this information.

Additional Information: Dr Finta was an internal medicine resident at the time of preparation and submission of the manuscript. Dr Yeow is a cardiology fellow and was a JAMA Internal Medicine Teachable Moment Editorial Fellow at the time of preparation and submission of the manuscript.

References
1.
Ouimet  S , Kavanagh  BP , Gottfried  SB , Skrobik  Y .  Incidence, risk factors and consequences of ICU delirium.   Intensive Care Med. 2007;33(1):66-73. doi:10.1007/s00134-006-0399-8PubMedGoogle ScholarCrossref
2.
Jacobi  J , Fraser  GL , Coursin  DB ,  et al; Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians.  Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.   Crit Care Med. 2002;30(1):119-141. doi:10.1097/00003246-200201000-00020PubMedGoogle ScholarCrossref
3.
Möhler  R , Nürnberger  C , Abraham  J , Köpke  S , Meyer  G .  Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings.   Cochrane Database Syst Rev. 2016;2016(12):CD012476. doi:10.1002/14651858.CD012476.Google Scholar
4.
Cleary  KK , Prescott  K .  The use of physical restraints in acute and long-term care: an updated review of the evidence, regulations, ethics, and legality.   Journal of Acute Care Physical Therapy. 2015;6(1):8-15. doi:10.1097/JAT.0000000000000005.Google ScholarCrossref
5.
Lach  HW , Leach  KM , Butcher  HK .  Evidence-based practice guideline: changing the practice of physical restraint use in acute care.   J Gerontol Nurs. 2016;42(2):17-26. doi:10.3928/00989134-20160113-04PubMedGoogle ScholarCrossref
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