Title |
Comfort and patient-centred care without excessive sedation: the eCASH concept
|
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Published in |
Intensive Care Medicine, April 2016
|
DOI | 10.1007/s00134-016-4297-4 |
Pubmed ID | |
Authors |
Jean-Louis Vincent, Yahya Shehabi, Timothy S. Walsh, Pratik P. Pandharipande, Jonathan A. Ball, Peter Spronk, Dan Longrois, Thomas Strøm, Giorgio Conti, Georg-Christian Funk, Rafael Badenes, Jean Mantz, Claudia Spies, Jukka Takala |
Abstract |
We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 12 | 24% |
United States | 9 | 18% |
Spain | 4 | 8% |
Australia | 3 | 6% |
Canada | 3 | 6% |
Ireland | 3 | 6% |
Netherlands | 2 | 4% |
Malaysia | 1 | 2% |
Mexico | 1 | 2% |
Other | 3 | 6% |
Unknown | 10 | 20% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 35 | 69% |
Practitioners (doctors, other healthcare professionals) | 10 | 20% |
Scientists | 5 | 10% |
Science communicators (journalists, bloggers, editors) | 1 | 2% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Spain | 1 | <1% |
Italy | 1 | <1% |
South Africa | 1 | <1% |
Unknown | 613 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 76 | 12% |
Other | 72 | 12% |
Student > Bachelor | 56 | 9% |
Researcher | 47 | 8% |
Student > Ph. D. Student | 47 | 8% |
Other | 166 | 27% |
Unknown | 152 | 25% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 230 | 37% |
Nursing and Health Professions | 137 | 22% |
Pharmacology, Toxicology and Pharmaceutical Science | 10 | 2% |
Unspecified | 9 | 1% |
Neuroscience | 7 | 1% |
Other | 43 | 7% |
Unknown | 180 | 29% |