Do we care? Physically restrained patients in the intensive care unit

The bundle focuses on ensuring patient progression and includes the participation of families to assist with the reduction of early adverse outcomes (such as prolonged length of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, infections, delirium) and late adverse outcomes (such as post-traumatic stress disorder and ICU-acquired weakness). [...]the multidisciplinary team is focused on the patient in order to ensure (a) early reduction/removal of sedation, (b) weaning from mechanical ventilation and the reduction of immobility, (c) avoidance of delirium and involving the patient and their relatives in caring activities by promoting a safe environment. The PFCC includes strategies oriented towards prevention of agitation and promotion of orientation such as the engagement of relatives in the care process, pain management, comfort promotion and early mobilization, (e.g., television, distraction devices, music therapy, eyeglasses and hearing aids), regulation of the sleep-wake cycle, reduction of invasive devices (Lynn, 2017; Dolan, 2017). A multicomponent interventional approach should also include the application of a restraint bundle, educational interventions about physical restraints and its alternatives and decisional aids which can affect the culture of safety and the attitudes of personnel toward physical restraint use (Alostaz et al., 2021). [...]a “zero restraint” paradigm “requires an approach to safety from a holistic perspective, with the involvement of all team members and the family” (Acevedo-Nuevo et al., 2021).