Comfort and patient-centred care without excessive sedation: the eCASH concept.
Identifieur interne : 001E06 ( PubMed/Corpus ); précédent : 001E05; suivant : 001E07Comfort and patient-centred care without excessive sedation: the eCASH concept.
Auteurs : Jean-Louis Vincent ; Yahya Shehabi ; Timothy S. Walsh ; Pratik P. Pandharipande ; Jonathan A. Ball ; Peter Spronk ; Dan Longrois ; Thomas Str M ; Giorgio Conti ; Georg-Christian Funk ; Rafael Badenes ; Jean Mantz ; Claudia Spies ; Jukka TakalaSource :
- Intensive care medicine [ 1432-1238 ] ; 2016.
English descriptors
- KwdEn :
- Analgesia (methods), Analgesics, Opioid (adverse effects), Benzodiazepines (adverse effects), Conscious Sedation, Critical Care (standards), Deep Sedation (adverse effects), Delirium (drug therapy), Humans, Hypnotics and Sedatives (therapeutic use), Intensive Care Units (standards), Ketamine (therapeutic use), Pain Management (methods), Patient Comfort, Patient-Centered Care (methods), Psychomotor Agitation (drug therapy), Risk Factors, Time Factors.
- MESH :
- chemical , adverse effects : Analgesics, Opioid, Benzodiazepines.
- adverse effects : Deep Sedation.
- drug therapy : Delirium, Psychomotor Agitation.
- methods : Analgesia, Pain Management, Patient-Centered Care.
- standards : Critical Care, Intensive Care Units.
- chemical , therapeutic use : Hypnotics and Sedatives, Ketamine.
- Conscious Sedation, Humans, Patient Comfort, Risk Factors, Time Factors.
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.
DOI: 10.1007/s00134-016-4297-4
PubMed: 27075762
Links to Exploration step
pubmed:27075762Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Comfort and patient-centred care without excessive sedation: the eCASH concept.</title><author><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name><affiliation><nlm:affiliation>Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.</nlm:affiliation></affiliation></author><author><name sortKey="Shehabi, Yahya" sort="Shehabi, Yahya" uniqKey="Shehabi Y" first="Yahya" last="Shehabi">Yahya Shehabi</name><affiliation><nlm:affiliation>Program of Critical Care, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Melbourne, VIC, 3800, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Walsh, Timothy S" sort="Walsh, Timothy S" uniqKey="Walsh T" first="Timothy S" last="Walsh">Timothy S. Walsh</name><affiliation><nlm:affiliation>Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Pandharipande, Pratik P" sort="Pandharipande, Pratik P" uniqKey="Pandharipande P" first="Pratik P" last="Pandharipande">Pratik P. Pandharipande</name><affiliation><nlm:affiliation>Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ball, Jonathan A" sort="Ball, Jonathan A" uniqKey="Ball J" first="Jonathan A" last="Ball">Jonathan A. 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Walsh</name><affiliation><nlm:affiliation>Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Pandharipande, Pratik P" sort="Pandharipande, Pratik P" uniqKey="Pandharipande P" first="Pratik P" last="Pandharipande">Pratik P. Pandharipande</name><affiliation><nlm:affiliation>Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Ball, Jonathan A" sort="Ball, Jonathan A" uniqKey="Ball J" first="Jonathan A" last="Ball">Jonathan A. Ball</name><affiliation><nlm:affiliation>Department of Intensive Care Medicine, St George's Hospital, London, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Spronk, Peter" sort="Spronk, Peter" uniqKey="Spronk P" first="Peter" last="Spronk">Peter Spronk</name><affiliation><nlm:affiliation>Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Longrois, Dan" sort="Longrois, Dan" uniqKey="Longrois D" first="Dan" last="Longrois">Dan Longrois</name><affiliation><nlm:affiliation>Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Str M, Thomas" sort="Str M, Thomas" uniqKey="Str M T" first="Thomas" last="Str M">Thomas Str M</name><affiliation><nlm:affiliation>Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.</nlm:affiliation></affiliation></author><author><name sortKey="Conti, Giorgio" sort="Conti, Giorgio" uniqKey="Conti G" first="Giorgio" last="Conti">Giorgio Conti</name><affiliation><nlm:affiliation>Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Funk, Georg Christian" sort="Funk, Georg Christian" uniqKey="Funk G" first="Georg-Christian" last="Funk">Georg-Christian Funk</name><affiliation><nlm:affiliation>Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.</nlm:affiliation></affiliation></author><author><name sortKey="Badenes, Rafael" sort="Badenes, Rafael" uniqKey="Badenes R" first="Rafael" last="Badenes">Rafael Badenes</name><affiliation><nlm:affiliation>Department of Anesthesiology and Surgical-Trauma Intensive Care, University Hospital Clinic Valencia, Valencia, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Mantz, Jean" sort="Mantz, Jean" uniqKey="Mantz J" first="Jean" last="Mantz">Jean Mantz</name><affiliation><nlm:affiliation>Department of Anesthesia and Intensive Care, European Hospital Georges Pompidou, Paris Descartes University, Paris, France.</nlm:affiliation></affiliation></author><author><name sortKey="Spies, Claudia" sort="Spies, Claudia" uniqKey="Spies C" first="Claudia" last="Spies">Claudia Spies</name><affiliation><nlm:affiliation>Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Takala, Jukka" sort="Takala, Jukka" uniqKey="Takala J" first="Jukka" last="Takala">Jukka Takala</name><affiliation><nlm:affiliation>Department of Intensive Care Medicine, Berne University Hospital and University of Berne, Berne, Switzerland.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Intensive care medicine</title><idno type="eISSN">1432-1238</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Analgesia (methods)</term><term>Analgesics, Opioid (adverse effects)</term><term>Benzodiazepines (adverse effects)</term><term>Conscious Sedation</term><term>Critical Care (standards)</term><term>Deep Sedation (adverse effects)</term><term>Delirium (drug therapy)</term><term>Humans</term><term>Hypnotics and Sedatives (therapeutic use)</term><term>Intensive Care Units (standards)</term><term>Ketamine (therapeutic use)</term><term>Pain Management (methods)</term><term>Patient Comfort</term><term>Patient-Centered Care (methods)</term><term>Psychomotor Agitation (drug therapy)</term><term>Risk Factors</term><term>Time Factors</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Analgesics, Opioid</term><term>Benzodiazepines</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Deep Sedation</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Delirium</term><term>Psychomotor Agitation</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Analgesia</term><term>Pain Management</term><term>Patient-Centered Care</term></keywords><keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Critical Care</term><term>Intensive Care Units</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Hypnotics and Sedatives</term><term>Ketamine</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Conscious Sedation</term><term>Humans</term><term>Patient Comfort</term><term>Risk Factors</term><term>Time Factors</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27075762</PMID><DateCreated><Year>2016</Year><Month>04</Month><Day>27</Day></DateCreated><DateCompleted><Year>2017</Year><Month>10</Month><Day>11</Day></DateCompleted><DateRevised><Year>2017</Year><Month>10</Month><Day>11</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1432-1238</ISSN><JournalIssue CitedMedium="Internet"><Volume>42</Volume><Issue>6</Issue><PubDate><Year>2016</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Intensive care medicine</Title><ISOAbbreviation>Intensive Care Med</ISOAbbreviation></Journal><ArticleTitle>Comfort and patient-centred care without excessive sedation: the eCASH concept.</ArticleTitle><Pagination><MedlinePgn>962-71</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s00134-016-4297-4</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Vincent</LastName><ForeName>Jean-Louis</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shehabi</LastName><ForeName>Yahya</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Program of Critical Care, Faculty of Medicine, Nursing and Health Sciences, Monash Medical Centre, Monash University, Melbourne, VIC, 3800, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Walsh</LastName><ForeName>Timothy S</ForeName><Initials>TS</Initials><AffiliationInfo><Affiliation>Anaesthetics, Critical Care and Pain Medicine, Centre for Inflammation Research and School of Clinical Sciences, Edinburgh University, Edinburgh, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pandharipande</LastName><ForeName>Pratik P</ForeName><Initials>PP</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ball</LastName><ForeName>Jonathan A</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, St George's Hospital, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Spronk</LastName><ForeName>Peter</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Longrois</LastName><ForeName>Dan</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Département d'Anesthésie Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Université Paris-Diderot, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Strøm</LastName><ForeName>Thomas</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Conti</LastName><ForeName>Giorgio</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Pediatric ICU, Intensive Care and Anesthesia, Catholic University of Rome, Rome, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Funk</LastName><ForeName>Georg-Christian</ForeName><Initials>GC</Initials><AffiliationInfo><Affiliation>Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Badenes</LastName><ForeName>Rafael</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Surgical-Trauma Intensive Care, University Hospital Clinic Valencia, Valencia, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mantz</LastName><ForeName>Jean</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Anesthesia and Intensive Care, European Hospital Georges Pompidou, Paris Descartes University, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Spies</LastName><ForeName>Claudia</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Takala</LastName><ForeName>Jukka</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Berne University Hospital and University of Berne, Berne, Switzerland.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>04</Month><Day>13</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Intensive Care Med</MedlineTA><NlmUniqueID>7704851</NlmUniqueID><ISSNLinking>0342-4642</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000701">Analgesics, Opioid</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006993">Hypnotics and Sedatives</NameOfSubstance></Chemical><Chemical><RegistryNumber>12794-10-4</RegistryNumber><NameOfSubstance UI="D001569">Benzodiazepines</NameOfSubstance></Chemical><Chemical><RegistryNumber>690G0D6V8H</RegistryNumber><NameOfSubstance UI="D007649">Ketamine</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="Cites"><RefSource>Crit Care Med. 2015 Apr;43(4):865-73</RefSource><PMID Version="1">25517476</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Acta Anaesthesiol Scand. 2014 Nov;58(10):1165-81</RefSource><PMID Version="1">25124340</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lancet. 2008 Jan 12;371(9607):126-34</RefSource><PMID Version="1">18191684</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>JAMA. 2012 Mar 21;307(11):1151-60</RefSource><PMID Version="1">22436955</PMID></CommentsCorrections><CommentsCorrections 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