Romain Sonneville, Camille Couffignal, Florian Sigaud, Michaël Thy, Virginie Godard, Juliette Audibert, Damien Contou, Adam CELIER, Michel Djibré, Thomas Rambaud, Pierre Jaquet, Armand Mekontso Dessap, Claire Bourel, Romane Belot, C. Roy, Fariza Nait Sidenas, Fatiha Essardy, Jean-François Timsit, Renaud Cornic, Lila Bouadma, R2D2-ICU Investigator Study Group, G. Abgrall, Romain Arrestier, Juliette Audibert, Jean-Loup Augy, François Bagate, Pierre Bay, Erwan Begot, Adel BEN SALAH, Brice BENELLI, Enora Berti, Astrid BERTIER, Alexandra Beurton, Pierre-Antoine Billiet, Lila Bouadma, Joanna Bougnaud, Anne-Laure Bouilland, Mohamed Ahmed Boujelben, Côme Bureau, Clara CANDILLE, Erwann Cariou, Guillaume Carteaux, Jenifer Catano, Pedro Cavaleiro, Adam CELIER, Pierre Chafiotte, Giulia CIRILLO, Sébastien CLERC, Alexandre Conia, Charlotte Cordier, Louis-Marie COUPRY, Daniel DA SILVA, Anaïs Dartevel, Étienne de Montmollin, Nina de Montmollin, Nicolas DE PROST, Maxens Decavèle, Robin Déléris, Cyrielle Desnos, Julien Dessajan, Marie-Claire DIEMOZ, Hermann Do Rego, Julien DO VALE, Martin Dres, Etienne Dufranc, Michaël Ejzenberg, A. Elabbadi, Pierre-Edouard FLOCH, Quentin Fossé, Thomas Frapard, Antoine Gaillet, Louis-Marie Galerneau, Ségolène Gendreau, Pedro GONCALVES CAVALEIRO, Olivier Gontier, Mouldi Hamrouni, Anne-Fleur Haudebourg, Luc Haudebourg, Florian Jolly, Julien Le Marec, Pascale Labedade, Jean-Rémi Lavillegrand, Marie Lecronier, Julien Lopinto, Paul Masi, Julien MAYAUX, Sophie Menat, Elsa MONCOMBLE, Élise Morawiec, Sophie NAGLE, Safaa Nemlaghi, Benjamin Picard, Jérémie Pichon, Henri PLAIS, Keyvan Razazi, Guillaume Rigault, Florian Sigaud, Romain Sonneville, Tona Tchoubou, Michaël Thy
Importance: The effect of wrist-strap physical restraints on outcomes in patients receiving mechanical ventilation in the intensive care unit (ICU) remains uncertain. Objective: To investigate the effect of a low-use wrist-strap physical restraint strategy in critically ill patients receiving invasive mechanical ventilation. Design, Setting, and Participants: 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. Interventions: 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 ≥3 [on a scale from -5 (unresponsive) to 4 (combative)]; n = 201) or a liberal, high-use strategy (wrist straps applied systematically and reassessed daily; n = 204). Discontinuation of restraints was allowed in patients who were awake or extubated without delirium (measured via the Confusion Assessment Method for the ICU). Main Outcomes and Measures: 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. Results: 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, -0.71 to 1.46]; P = .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. Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT04273360.