Atuação da equipe de enfermagem nos processos de contenção mecânica de pacientes com delirium na UTI: práticas, desafios e implicações éticas

Abstract

Introduction: This literature review addresses delirium in critically ill patients, characterized by acute changes in attention, awareness, and cognition, with hypoactive, hyperactive, or mixed manifestations. Associated with the use of sedatives, mechanical ventilation, and the stressful ICU environment, delirium often requires measures such as physical restraint—understood as a temporary restriction to prevent harm—but surrounded by ethical and care dilemmas. Objective: To analyze evidence on the practices, challenges, and ethical implications of nursing teams in restraining ICU patients with delirium. Methodology: Integrative review conducted in MEDLINE/PubMed, SciELO, LILACS, and BDENF databases (2020–2025), with a two-phase selection and quality analysis. Results: Studies identified high prevalence among adults and older adults, recurrent use of upper-limb restraints, incomplete documentation, and lack of formal prescription. Practices vary according to unit culture and staff training level. Protocols including daily delirium screening, sedation pauses, early mobilization, pain management, sleep hygiene, and family participation proved effective in reducing restraint use. Conclusion: Restraint should remain an exceptional, brief, and proportional measure, preceded by non-pharmacological interventions and accompanied by continuous documentation, reassessment, ongoing education, and structured safety protocols.