Do low-use wrist restraints help patients stay free of delirium longer?
Delirium is a common and serious complication in intensive care unit (ICU) patients, especially those on mechanical ventilation. Physical restraints like wrist straps are sometimes used to prevent patients from pulling out tubes, but their effect on delirium is unclear. A 2025 randomized trial directly compared a low-use (restrictive) wrist restraint strategy to a high-use (liberal) strategy. The study found no significant difference in the number of days patients stayed free of delirium or coma between the two groups.
What the research says
A 2025 open-label randomized clinical trial across 10 French ICUs enrolled 405 adults who had just started mechanical ventilation 4. Patients were randomly assigned to either a low-use strategy (wrist straps avoided unless severe agitation) or a high-use strategy (wrist straps applied systematically) 4. The primary outcome was the number of days alive without delirium or coma within 28 days. The results showed no significant difference between the groups: the low-use strategy did not increase delirium-free days compared to the high-use strategy 4. This suggests that simply reducing wrist restraint use does not, by itself, prevent delirium. Other factors, such as sedation depth and medication choices, may have a stronger impact on delirium. For instance, a meta-analysis found that deep sedation is associated with higher delirium risk in ICU patients 3, and another study linked benzodiazepine use to increased next-day delirium in children 7. Nurse-led sedation protocols have been shown to reduce delirium and mortality 5.
What to ask your doctor
- What is our ICU's current approach to using physical restraints, and is there a written protocol?
- How do you decide when to use wrist restraints versus other methods to prevent tube dislodgement?
- Are there non-restraint strategies, like sedation protocols or early mobilization, that might reduce delirium risk?
- What medications are typically used for sedation in my loved one, and how do they affect delirium risk?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.