Optimizing sedation in the ICU: the eCASH concept

Abstract

Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept is a threepronged approach to minimize sedation in ICU patients by ensuring adequate and timely analgesia is received; patient-centred care is encouraged, including communication aids, noise reduction to facilitate good sleep patterns, early mobilization, and family involvement; and, when needed, sedation is targeted to individual needs and regularly reassessed, with patients kept calm, comfortable and able to cooperate.

The Effect of Foot Reflexology on Physiological Indicators and Mechanical Ventilation Weaning Time among Open-Heart Surgery Patients

“…Moreover, the use of sedatives post cardiac surgery in ICU to improve MV tolerance and reduce metabolic demands during hemodynamic and respiratory instability is very common [6]. However, these agents have several negative consequences on patients' conditions, and may lead to prolongation of MV, over-sedation, delirium, and hemodynamic instability [7].…”

“…There are various pharmacological and non-pharmacological methods for reducing patients' stress, pain and anxiety [11]. However, there are several complications related to pharmacological management such as disturbed level of consciousness and increasing the risk of drug dependence [7]. Currently, Nonpharmacological interventions, such as distraction, relaxing music, relaxation techniques, massage therapy and biofeedback are used by nurses as measures for reducing patients' anxiety, and enhancing their healing and general health [11,12].…”

Effect of Nurse-Led Goal-Directed Lung Physical Therapy on the Prognosis of Pneumonia in Sepsis Patients in the ICU: A Prospective Cohort Study

“…(2) Daily assessment of sedation depth, with adjustment of sedative dose to maintain the Richmond agitation-sedation score (RASS) at À2 to 1. 16 (3) Oral care with compound chlorhexidine 3 times a day. (4) Sputum aspiration as needed or every 2 h. (5) Use of subglottic suction device with continuous Treatment group (phase 2).…”

Enhanced Recovery in Surgical Intensive Care: A Review

“…In the most cases the objective is for the patient to remain calm, cooperative and comfortable. The concept of “e CASH” ( e arly C omfort using A nalgesia, minimal S edatives and maximal H uman care) is being introduced to guide clinicians ( 5 – 7 ).…”

“…Counseling, emotional support, and humanistic approach should be implemented in our everyday work. Many non-pharmacological modalities can be employed in sleep promotion and as alternative means of communication ( 5 – 7 ).…”