The use of physical restraints to prevent unplanned extubation or interference with other medical devices is an ethically troubling yet deeply entrenched practice. Lawson et al note that physical restraint use is highly prevalent in intensive care units, despite regulatory changes and studies that show restrained patients experience adverse events including agitation, device removal, use of psychoactive medications, and a higher risk of mortality. Why does this practice continue?

In the moment when a confused patient in a busy intensive care unit is repeatedly reaching for the endotracheal tube, restraint use appears to be an efficient and effective intervention to prevent self-inflicted trauma and reintubation. In fact, we may feel we have no choice but to apply restraints. However, if we put that moment in a different context, consider it not as an isolated decision but as part of a trajectory of care...

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