S01E29 | Restraints Don’t Fix Delirium: R2D2 ICU Trial (JAMA 2026)

In this episode of PRISM Rounds, we review the R2D2 ICU randomized trial (JAMA, March 2026) evaluating restrictive vs liberal physical restraint strategies in mechanically ventilated ICU patients.Bottom line: less restraint did not improve delirium or coma—but it also did not increase harm.We break down the trial design, key results, and the bedside implications for sedation strategy, delirium prevention, patient safety, and ICU culture. This is a practice-challenging study that questions routine restraint use while emphasizing individualized, patient-centered care.Key themes: delirium, sedation, safety vs harm, ICU workflow, ethics, and bedside decision-making.PubMed search links:R2D2 ICU Trial:https://pubmed.ncbi.nlm.nih.gov/41841304/Editorial:https://pubmed.ncbi.nlm.nih.gov/41841296/Tags#FOAMed #FOAMcc #FOAMICU #MedEd #MedTwitter #CriticalCare #ICU #IntensiveCare #PulmCrit #Resus #JournalClub #EvidenceBasedMedicine #EBM #MedicalEducation #ClinicalTrials #JAMA #Delirium #Sedation #MechanicalVentilation #Ventilator #PatientSafety #ICUculture #Restraints #AirwayManagement #ARDS #Sepsis #HospitalMedicine #EmergencyMedicine #EMCrit #ICUrounds #BedsideTeaching #PCCM #PulmonaryCriticalCare #TraineeEducation #MedPodcast #CriticalCareMedicine #Intensivist #NeuroICU #AcuteCare #MedicalPodcast