Hui Hongyu, Fang Xu, Ju Lei, Tang Lingling, Zhang Hui, Wang Miao, Jiang Jia
Department of Critical Care Medicine, The Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China.
Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Br J Hosp Med (Lond). 2025 May 23;86(5):1-14. doi: 10.12968/hmed.2024.0987. Epub 2025 May 19.
Early Comfort using Analgesia, minimal Sedatives, and maximal Human care (eCASH) is a patient-centered sedation strategy aimed at reducing the use of sedative drugs and improving patient comfort. Therefore, this study evaluated the effectiveness of a nurse-led eCASH sedation strategy in mechanically ventilated patients. This retrospective cohort study included 149 patients who received mechanical ventilation in the intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University between May 2020 and May 2024. Patients were divided into two groups: the observation group (eCASH sedation group, n = 70), which received nurse-led eCASH sedation, and the control group (traditional sedation group, n = 79), which underwent physician-led traditional sedation strategies. Baseline characteristics, analgesic and sedative use, analgesia and sedation outcomes, duration of mechanical ventilation, ICU stay, length of hospital stay, and incidence of delirium were compared between the two groups. The observation group received a significantly higher dose of fentanyl within the first 24 hours of mechanical ventilation compared to the control group ( = 0.001). However, there was no significant difference in fentanyl use at 48 and 72 hours between the two groups ( > 0.05). Dexmedetomidine use in the observation group was significantly lower than in the control group at 24, 48, and 72 hours ( < 0.05). Moreover, no significant difference was observed in the use of propofol between the two groups ( > 0.05). The observation group had a significantly higher analgesia success rate within 72 hours ( = 0.027), although the sedation success rate was not significantly different ( > 0.05). Both groups showed significant improvement over time in Richmond Agitation-Sedation Scale (RASS) and Critical-Care Pain Observation Tool (CPOT) scores ( < 0.001), with the observation group demonstrating a significantly faster improvement in analgesia effectiveness compared to the control group ( = 0.015). The duration of mechanical ventilation was significantly shorter in the observation group ( = 0.011), while the incidence of delirium was lower but not statistically significant ( = 0.519). Additionally, there were no statistically significant differences in ICU stay duration and length of hospital stay between the two groups ( > 0.05). The nurse-led eCASH sedation strategy significantly reduces analgesic use, shortens mechanical ventilation duration, and improves analgesia outcomes in mechanically ventilated patients. The effectiveness of sedation and incidence of delirium within the eCASH were comparable to those of traditional sedation.
早期舒适化镇痛、最小化镇静及最大化人文关怀（eCASH）是一种以患者为中心的镇静策略，旨在减少镇静药物的使用并提高患者舒适度。因此，本研究评估了护士主导的eCASH镇静策略在机械通气患者中的有效性。这项回顾性队列研究纳入了2020年5月至2024年5月期间在哈尔滨医科大学附属第二医院重症监护病房（ICU）接受机械通气的149例患者。患者分为两组：观察组（eCASH镇静组，n = 70），接受护士主导的eCASH镇静；对照组（传统镇静组，n = 79），采用医生主导的传统镇静策略。比较两组患者的基线特征、镇痛和镇静药物使用情况、镇痛和镇静效果、机械通气时间、ICU住院时间、住院时间及谵妄发生率。与对照组相比，观察组在机械通气的前24小时内芬太尼使用剂量显著更高（P = 0.001）。然而，两组在48小时和72小时时芬太尼使用量无显著差异（P > 0.05）。观察组在24小时、48小时和72小时时右美托咪定使用量显著低于对照组（P < 0.05）。此外，两组丙泊酚使用情况无显著差异（P > 0.05）。观察组在72小时内镇痛成功率显著更高（P = 0.027），尽管镇静成功率无显著差异（P > 0.05）。两组在里士满躁动 - 镇静量表（RASS）和重症监护疼痛观察工具（CPOT）评分上均随时间显著改善（P < 0.001），与对照组相比，观察组镇痛效果改善明显更快（P = 0.015）。观察组机械通气时间显著更短（P = 0.011），而谵妄发生率更低但无统计学意义（P = 0.519）。此外，两组在ICU住院时间和住院时间上无统计学显著差异（P > 0.05）。护士主导的eCASH镇静策略可显著减少机械通气患者的镇痛药物使用，缩短机械通气时间，并改善镇痛效果。eCASH镇静的效果及谵妄发生率与传统镇静相当。
