Abstract
Optimizing sedation in the ICU: the eCASH concept
Highlights
Sedation has been widely and liberally used in critically ill patients, since the earliest days of intensive care units (ICUs), largely to facilitate uncomfortable mechanical ventilation. [1] But our approach to sedation has changed markedly in the last decade or so
Reflecting general attitudes to sedation at the time, two thirds of the units stated that the ideal depth of sedation was to have “a patient completely detached from the environment who was woken only on occasions”. [2] In a survey of American ICUs in 1990 [3], one third of respondents stated that they routinely used sedative agents in mechanically ventilated patients; 89% of the respondents stated that they used sedative agents to "suppress excessive or dangerous motor activity" and more than half said they used them "to promote sleep"
The latest guidelines from the American College of Critical Care Medicine recommend that “sedative medications be titrated to maintain a light rather than a deep level of sedation in adult ICU patients, unless clinically contraindicated”. [7] Importantly, sedation cannot be considered alone, but is intricately linked to analgesia and delirium in the so-called “ICU triad”. [1] This more moderate approach to sedation is embodied in the eCASH concept [8], which we will elaborate on in this chapter
Summary
Sedation has been widely and liberally used in critically ill patients, since the earliest days of intensive care units (ICUs), largely to facilitate uncomfortable mechanical ventilation. [1] But our approach to sedation has changed markedly in the last decade or so. (1) This more moderate approach to sedation is embodied in the eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept [8], which we will elaborate on in this chapter.
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