Comfort and patient-centred care without excessive sedation: the eCASH concept
Identifieur interne : 000A65 ( Pmc/Checkpoint ); précédent : 000A64; suivant : 000A66Comfort and patient-centred care without excessive sedation: the eCASH concept
Auteurs : Jean-Louis Vincent [Belgique] ; Yahya Shehabi ; Timothy S. Walsh [Royaume-Uni] ; Pratik P. Pandharipande [États-Unis] ; Jonathan A. Ball [Royaume-Uni] ; Peter Spronk [Pays-Bas] ; Dan Longrois [France] ; Thomas Str M [Danemark] ; Giorgio Conti [Italie] ; Georg-Christian Funk [Autriche] ; Rafael Badenes [Espagne] ; Jean Mantz [France] ; Claudia Spies [Allemagne] ; Jukka Takala [Suisse]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2016.
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.
Url:
DOI: 10.1007/s00134-016-4297-4
PubMed: 27075762
PubMed Central: 4846689
Affiliations:
- Allemagne, Autriche, Belgique, Danemark, Espagne, France, Italie, Pays-Bas, Royaume-Uni, Suisse, États-Unis
- Angleterre, Berlin, Canton de Berne, Grand Londres, Latium, Tennessee, Vienne (Autriche), Écosse, Île-de-France
- Berlin, Berne, Londres, Paris, Rome, Vienne (Autriche), Édimbourg
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PMC:4846689Le document en format XML
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<author><name sortKey="Str M, Thomas" sort="Str M, Thomas" uniqKey="Str M T" first="Thomas" last="Str M">Thomas Str M</name>
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<author><name sortKey="Conti, Giorgio" sort="Conti, Giorgio" uniqKey="Conti G" first="Giorgio" last="Conti">Giorgio Conti</name>
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<author><name sortKey="Funk, Georg Christian" sort="Funk, Georg Christian" uniqKey="Funk G" first="Georg-Christian" last="Funk">Georg-Christian Funk</name>
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<author><name sortKey="Mantz, Jean" sort="Mantz, Jean" uniqKey="Mantz J" first="Jean" last="Mantz">Jean Mantz</name>
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<front><div type="abstract" xml:lang="en"><p>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.</p>
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<author><name sortKey="Bellomo, R" uniqKey="Bellomo R">R Bellomo</name>
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<author><name sortKey="Reade, Mc" uniqKey="Reade M">MC Reade</name>
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<author><name sortKey="Bailey, M" uniqKey="Bailey M">M Bailey</name>
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<author><name sortKey="Howe, B" uniqKey="Howe B">B Howe</name>
</author>
<author><name sortKey="Mcarthur, C" uniqKey="Mcarthur C">C McArthur</name>
</author>
<author><name sortKey="Seppelt, Im" uniqKey="Seppelt I">IM Seppelt</name>
</author>
<author><name sortKey="Webb, S" uniqKey="Webb S">S Webb</name>
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<author><name sortKey="Weisbrodt, L" uniqKey="Weisbrodt L">L Weisbrodt</name>
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<author><name sortKey="Chan, L" uniqKey="Chan L">L Chan</name>
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<author><name sortKey="Kadiman, S" uniqKey="Kadiman S">S Kadiman</name>
</author>
<author><name sortKey="Alias, A" uniqKey="Alias A">A Alias</name>
</author>
<author><name sortKey="Ismail, Wn" uniqKey="Ismail W">WN Ismail</name>
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<author><name sortKey="Tan, Ma" uniqKey="Tan M">MA Tan</name>
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<author><name sortKey="Khoo, Tm" uniqKey="Khoo T">TM Khoo</name>
</author>
<author><name sortKey="Ali, Sb" uniqKey="Ali S">SB Ali</name>
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<author><name sortKey="Saman, Ma" uniqKey="Saman M">MA Saman</name>
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<author><name sortKey="Shaltut, A" uniqKey="Shaltut A">A Shaltut</name>
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<author><name sortKey="Tan, Cc" uniqKey="Tan C">CC Tan</name>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Intensive Care Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Intensive Care Med</journal-id>
<journal-title-group><journal-title>Intensive Care Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">0342-4642</issn>
<issn pub-type="epub">1432-1238</issn>
<publisher><publisher-name>Springer Berlin Heidelberg</publisher-name>
<publisher-loc>Berlin/Heidelberg</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27075762</article-id>
<article-id pub-id-type="pmc">4846689</article-id>
<article-id pub-id-type="publisher-id">4297</article-id>
<article-id pub-id-type="doi">10.1007/s00134-016-4297-4</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review</subject>
</subj-group>
</article-categories>
<title-group><article-title>Comfort and patient-centred care without excessive sedation: the eCASH concept</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Vincent</surname>
<given-names>Jean-Louis</given-names>
</name>
<address><phone>+32 2 555 3380</phone>
<email>jlvincen@ulb.ac.be</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Shehabi</surname>
<given-names>Yahya</given-names>
</name>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Walsh</surname>
<given-names>Timothy S.</given-names>
</name>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Pandharipande</surname>
<given-names>Pratik P.</given-names>
</name>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ball</surname>
<given-names>Jonathan A.</given-names>
</name>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Spronk</surname>
<given-names>Peter</given-names>
</name>
<xref ref-type="aff" rid="Aff6"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Longrois</surname>
<given-names>Dan</given-names>
</name>
<xref ref-type="aff" rid="Aff7"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Strøm</surname>
<given-names>Thomas</given-names>
</name>
<xref ref-type="aff" rid="Aff8"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Conti</surname>
<given-names>Giorgio</given-names>
</name>
<xref ref-type="aff" rid="Aff9"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Funk</surname>
<given-names>Georg-Christian</given-names>
</name>
<xref ref-type="aff" rid="Aff10"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Badenes</surname>
<given-names>Rafael</given-names>
</name>
<xref ref-type="aff" rid="Aff11"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mantz</surname>
<given-names>Jean</given-names>
</name>
<xref ref-type="aff" rid="Aff12"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Spies</surname>
<given-names>Claudia</given-names>
</name>
<xref ref-type="aff" rid="Aff13"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Takala</surname>
<given-names>Jukka</given-names>
</name>
<xref ref-type="aff" rid="Aff14"></xref>
</contrib>
<aff id="Aff1"><label></label>
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium</aff>
<aff id="Aff2"><label></label>
Program of Critical Care, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Melbourne, VIC 3800 Australia</aff>
<aff id="Aff3"><label></label>
Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK</aff>
<aff id="Aff4"><label></label>
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN USA</aff>
<aff id="Aff5"><label></label>
Department of Intensive Care Medicine, St George’s Hospital, London, UK</aff>
<aff id="Aff6"><label></label>
Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands</aff>
<aff id="Aff7"><label></label>
Département d’Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France</aff>
<aff id="Aff8"><label></label>
Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark</aff>
<aff id="Aff9"><label></label>
Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy</aff>
<aff id="Aff10"><label></label>
Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria</aff>
<aff id="Aff11"><label></label>
Department of Anesthesiology and Surgical-Trauma Intensive Care, University Hospital Clinic Valencia, Valencia, Spain</aff>
<aff id="Aff12"><label></label>
Department of Anesthesia and Intensive Care, European Hospital Georges Pompidou, Paris Descartes University, Paris, France</aff>
<aff id="Aff13"><label></label>
Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany</aff>
<aff id="Aff14"><label></label>
Department of Intensive Care Medicine, Berne University Hospital and University of Berne, Berne, Switzerland</aff>
</contrib-group>
<pub-date pub-type="epub"><day>13</day>
<month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>13</day>
<month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub"><year>2016</year>
</pub-date>
<volume>42</volume>
<fpage>962</fpage>
<lpage>971</lpage>
<history><date date-type="received"><day>21</day>
<month>12</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>26</day>
<month>2</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s) 2016</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>
), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.</license-p>
</license>
</permissions>
<abstract id="Abs1"><p>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.</p>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>ICU</kwd>
<kwd>Pain</kwd>
<kwd>Analgesia</kwd>
<kwd>Sedation</kwd>
<kwd>eCASH</kwd>
</kwd-group>
<funding-group><award-group><funding-source><institution>Orion Pharma</institution>
</funding-source>
</award-group>
</funding-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© Springer-Verlag Berlin Heidelberg and ESICM 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Allemagne</li>
<li>Autriche</li>
<li>Belgique</li>
<li>Danemark</li>
<li>Espagne</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Berlin</li>
<li>Canton de Berne</li>
<li>Grand Londres</li>
<li>Latium</li>
<li>Tennessee</li>
<li>Vienne (Autriche)</li>
<li>Écosse</li>
<li>Île-de-France</li>
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<li>Berne</li>
<li>Londres</li>
<li>Paris</li>
<li>Rome</li>
<li>Vienne (Autriche)</li>
<li>Édimbourg</li>
</settlement>
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<tree><noCountry><name sortKey="Shehabi, Yahya" sort="Shehabi, Yahya" uniqKey="Shehabi Y" first="Yahya" last="Shehabi">Yahya Shehabi</name>
</noCountry>
<country name="Belgique"><region name="Vienne (Autriche)"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name>
</region>
</country>
<country name="Royaume-Uni"><region name="Écosse"><name sortKey="Walsh, Timothy S" sort="Walsh, Timothy S" uniqKey="Walsh T" first="Timothy S." last="Walsh">Timothy S. Walsh</name>
</region>
<name sortKey="Ball, Jonathan A" sort="Ball, Jonathan A" uniqKey="Ball J" first="Jonathan A." last="Ball">Jonathan A. Ball</name>
</country>
<country name="États-Unis"><region name="Tennessee"><name sortKey="Pandharipande, Pratik P" sort="Pandharipande, Pratik P" uniqKey="Pandharipande P" first="Pratik P." last="Pandharipande">Pratik P. Pandharipande</name>
</region>
</country>
<country name="Pays-Bas"><noRegion><name sortKey="Spronk, Peter" sort="Spronk, Peter" uniqKey="Spronk P" first="Peter" last="Spronk">Peter Spronk</name>
</noRegion>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Longrois, Dan" sort="Longrois, Dan" uniqKey="Longrois D" first="Dan" last="Longrois">Dan Longrois</name>
</region>
<name sortKey="Mantz, Jean" sort="Mantz, Jean" uniqKey="Mantz J" first="Jean" last="Mantz">Jean Mantz</name>
</country>
<country name="Danemark"><noRegion><name sortKey="Str M, Thomas" sort="Str M, Thomas" uniqKey="Str M T" first="Thomas" last="Str M">Thomas Str M</name>
</noRegion>
</country>
<country name="Italie"><region name="Latium"><name sortKey="Conti, Giorgio" sort="Conti, Giorgio" uniqKey="Conti G" first="Giorgio" last="Conti">Giorgio Conti</name>
</region>
</country>
<country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Funk, Georg Christian" sort="Funk, Georg Christian" uniqKey="Funk G" first="Georg-Christian" last="Funk">Georg-Christian Funk</name>
</region>
</country>
<country name="Espagne"><noRegion><name sortKey="Badenes, Rafael" sort="Badenes, Rafael" uniqKey="Badenes R" first="Rafael" last="Badenes">Rafael Badenes</name>
</noRegion>
</country>
<country name="Allemagne"><region name="Berlin"><name sortKey="Spies, Claudia" sort="Spies, Claudia" uniqKey="Spies C" first="Claudia" last="Spies">Claudia Spies</name>
</region>
</country>
<country name="Suisse"><region name="Canton de Berne"><name sortKey="Takala, Jukka" sort="Takala, Jukka" uniqKey="Takala J" first="Jukka" last="Takala">Jukka Takala</name>
</region>
</country>
</tree>
</affiliations>
</record>
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