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Comfort and patient-centred care without excessive sedation: the eCASH concept.

  • Vincent JL Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.
  • Shehabi Y Program of Critical Care, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Melbourne, VIC, 3800, Australia.
  • Walsh TS Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK.
  • Pandharipande PP Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
  • Ball JA Department of Intensive Care Medicine, St George's Hospital, London, UK.
  • Spronk P Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.
  • Longrois D Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.
  • Strøm T Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
  • Conti G Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy.
  • Funk GC Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.
  • Badenes R Department of Anesthesiology and Surgical-Trauma Intensive Care, University Hospital Clinic Valencia, Valencia, Spain.
  • Mantz J Department of Anesthesia and Intensive Care, European Hospital Georges Pompidou, Paris Descartes University, Paris, France.
  • Spies C Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Takala J Department of Intensive Care Medicine, Berne University Hospital and University of Berne, Berne, Switzerland.
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  • 2016-04-15
Published in:
  • Intensive care medicine. - 2016
Analgesia
ICU
Pain
Sedation
eCASH
Analgesia
Analgesics, Opioid
Benzodiazepines
Conscious Sedation
Critical Care
Deep Sedation
Delirium
Humans
Hypnotics and Sedatives
Intensive Care Units
Ketamine
Pain Management
Patient Comfort
Patient-Centered Care
Psychomotor Agitation
Risk Factors
Time Factors
English 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.
Language
  • English
Open access status
green
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Persistent URL
https://sonar.ch/global/documents/184822
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