Consider liberalizing restraint use in intubated patients with COVID-19

with the disease. Many of these patients also require prolonged mechanical ventilation.1 A study by Gueret and colleagues in a medical ICU found a self-extubation rate of 1.3 per 100 days of mechanical ventilation.2 The presence of agitation is associated with increased risk of self-extubation.3 The need for reintubation is associated with a high rate of pulmonary complications, such as aspiration, ventilator-associated pneumonia, prolonged duration of mechanical ventilation, and increased hospital stay.4 Self-extubation by patients with COVID-19 poses a significant hazard to healthcare workers, because person-to-person spread of severe acute respira-