Physical restraint in the emergency and intensive care units

Although widely used in medical settings, physical restraint remains a controversial issue for the general public, the patients and their relatives, as well as for the caregivers and the medical community. Physical restraint is considered as an emergency therapeutic decision but lacks a clear legal framework and evidence supporting its benefit-risk ratio remains poor. Before the implementation of physical restraint, a relational approach is warranted. Physical restraint will be undertaken only when this relational approach has failed. It warrants an initial medical prescription, certified devices, and implementation by five caregivers including one coordinator who informs the patient on the procedure, its duration, and goals. Vital signs should be carefully monitored as well as the occurrence of complications. Indication of physical restraint should be regularly challenged by the physician in charge. Physical restraint should be associated with a sedative treatment, which will be chosen according to the context of agitation: delirium due to organic or toxic causes, psychiatric or mixed agitation. Physical restraint and sedation should be considered as merely symptomatic measures and should not delay the etiological treatment of agitation. Heterogeneity of views regarding physical restraint in medical settings, owing to the poor level of evidence supporting its benefit-risk ratio, warrants better studies and the development of a specific ethical framework.