Face shields reduce physical restraint use in prolonged mechanically ventilated patients: a cohort study in a respiratory step-down unit

Objectives Physical restraints are commonly used to prevent unplanned self-extubation (USE) in mechanically ventilated patients but pose ethical and safety concerns. This study evaluated whether modified face shields could reduce physical restraint use in prolonged mechanical ventilation patients with a secondary aim exploring association with changes in USE rates. Design Retrospective cohort study. Setting An eight-bed respiratory step-down unit. Participants 526 patients admitted December 2015 to April 2021. Interventions Patients were divided into group 1 (123 patients, before April 2017) and group 2 (403 patients, admitted after April 2017) when a modified face shield was introduced. Measurements and main results The primary outcome of physical restraint use decreased significantly after the intervention: restraint days per 100 patient days declined from 19.6% to 5.7% (p<0.001). After adjusting for confounders, restraint reduction remained significant (rate ratio=0.35, 95% CI 0.30 to 0.41, p<0.001). For the secondary outcome, the reduction in USE events decreased from 0.91 to 0.17 events per 100 intubation days. However, after adjusting for confounders, this reduction did not reach statistical significance (OR=0.33, 95% CI 0.09 to 1.16, p=0.084). Given the small number of USE events (n=12), USE findings should be interpreted as exploratory. Conclusions Face shields significantly reduce physical restraint use in a respiratory step-down unit population. The observed trend toward decreased USE events warrants further investigation in larger trials. This approach may offer a safe alternative to traditional restraint in selected patient populations.