The R2D2-ICU trial (Sonneville et al., JAMA, 2026) enrolled 405 mechanically ventilated adults across 10 French ICUs, randomizing them to a restrictive physical restraint strategy — applied only for severe agitation (RASS ≥+3) — versus a liberal strategy with routine application and daily reassessment.

The primary outcome, days alive without coma or delirium in the first 14 days, was not significantly different between groups (6.67 vs 6.30 days). Secondary outcomes including delirium incidence, sedation requirements, self-extubation rate, and 90-day mortality also showed no meaningful difference.

This is a null result that carries a clear clinical message: in critically ill, heavily sedated patients, restraint policy in isolation is insufficient to improve delirium outcomes. Sedation depth and bundle-based care (ABCDEF) remain the primary levers.

📄 Source: Sonneville R et al. R2D2-ICU. JAMA 2026.

can i ask for the new video series for 2026 new sepsis campaign ?

I finished Evidence-based Management of Sepsis & Septic Shock! 🚀

Notice the femoral vein valves!

A non-conventional cardiac window, but clearly showing a pleural effusion, the Jellyfish sign of a collapsed lung, and the left ventricle with good contractility along with thickening of the posterior mitral valve leaflet