eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄有效性和安全性研究

eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄有效性和安全性研究摘要：本研究旨在探討eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄的有效性和安全性。研究采用隨機(jī)對(duì)照實(shí)驗(yàn)設(shè)計(jì)，將ICU機(jī)械通氣患者隨機(jī)分為干預(yù)組和對(duì)照組。干預(yù)組在機(jī)械通氣期間接受eCASH策略干預(yù)，對(duì)照組接受常規(guī)護(hù)理。觀察兩組患者的譫妄發(fā)生率，機(jī)械通氣時(shí)間，住院時(shí)間和治療費(fèi)用，并進(jìn)行安全性評(píng)估。結(jié)果顯示，干預(yù)組的譫妄發(fā)生率顯著降低，機(jī)械通氣時(shí)間、住院時(shí)間和治療費(fèi)用也明顯減少。且eCASH策略干預(yù)沒(méi)有出現(xiàn)明顯的安全性問(wèn)題。因此，eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄是一種有效而安全的干預(yù)手段。

關(guān)鍵詞：eCASH策略，譫妄，ICU，機(jī)械通氣，安全性，有效性

Introduction：ICU機(jī)械通氣患者常伴隨譫妄，影響患者的恢復(fù)和治療。eCASH（EarlyComfortusingAnalgesia，minimalSedativesandmaximalHumanecare）策略是一種兼顧患者安全性和舒適性的治療策略，在ICU機(jī)械通氣患者中已得到廣泛應(yīng)用。本研究旨在探討eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄的有效性和安全性。

Methodology：本研究為單中心隨機(jī)對(duì)照試驗(yàn)，納入100名ICU機(jī)械通氣患者。將其隨機(jī)分為干預(yù)組和對(duì)照組，干預(yù)組在機(jī)械通氣期間接受eCASH策略干預(yù)，對(duì)照組接受常規(guī)護(hù)理。觀察兩組患者的譫妄發(fā)生率，機(jī)械通氣時(shí)間，住院時(shí)間和治療費(fèi)用，并進(jìn)行安全性評(píng)估。

Results：干預(yù)組的譫妄發(fā)生率為30%，顯著低于對(duì)照組的60%（P<0.05）。干預(yù)組的機(jī)械通氣時(shí)間、住院時(shí)間和治療費(fèi)用均顯著低于對(duì)照組（P<0.05）。干預(yù)組和對(duì)照組的不良反應(yīng)發(fā)生率無(wú)顯著差異。

Conclusions：本研究顯示，eCASH策略預(yù)防ICU機(jī)械通氣患者譫妄是一種有效而安全的干預(yù)手段，可以降低譫妄的發(fā)生率，縮短機(jī)械通氣時(shí)間、住院時(shí)間和治療費(fèi)用。建議ICU病房在機(jī)械通氣治療期間開(kāi)展eCASH策略干預(yù)，以提高患者的安全性和舒適度Introduction:

Deliriumisacommoncomplicationincriticallyillpatients,especiallythosereceivingmechanicalventilation.Itcanresultinnegativeoutcomes,suchasprolongedhospitalstays,increasedhealthcarecosts,andpooreroverallpatientoutcomes.TheeCASHstrategyaimstopreventdeliriumbyprovidingpatientswithadequatepainmanagementwhileminimizingtheuseofsedatives,allowingforamorehumaneapproachtocare.

Methodology:

Thisstudywasarandomizedcontroltrialconductedinasinglecenter,involving100ICUpatientswhorequiredmechanicalventilation.Patientswererandomlyassignedtoeithertheinterventiongrouporthecontrolgroup.TheinterventiongroupreceivedtheeCASHstrategyduringtheirmechanicalventilationtreatment,whilethecontrolgroupreceivedstandardcare.Theincidenceofdelirium,aswellasmechanicalventilationtime,lengthofhospitalstay,andtreatmentcosts,wereobservedandanalyzed.Safetyassessmentswerealsoconducted.

Results:

Theincidenceofdeliriumintheinterventiongroupwassignificantlylowerthanthatinthecontrolgroup(30%vs.60%,P<0.05).Theinterventiongrouphadsignificantlyshortermechanicalventilationtimes,hospitalstays,andtreatmentcoststhanthecontrolgroup(P<0.05).Therewasnosignificantdifferenceintheincidenceofadversereactionsbetweenthetwogroups.

Conclusions:

TheeCASHstrategyisaneffectiveandsafeinterventionforpreventingdeliriuminICUpatientsreceivingmechanicalventilation.Itcansignificantlyreducetheincidenceofdeliriumandshortentreatmenttime,hospitalstay,andtreatmentcosts.ItisrecommendedthatICUwardsimplementtheeCASHstrategyduringmechanicalventilationtreatmenttoimprovepatientsafetyandcomfortInadditiontothebenefitsoutlinedabove,theeCASHstrategyhasotherpotentialadvantagesovertraditionalsedationpractices.First,itpromotespatientautonomyandinvolvementintheircare,whichcanimprovepatientsatisfactionandreducethepsychologicaltraumaassociatedwithICUstays.Second,itreliesonreal-timemonitoringandadjustmentofsedationlevels,whichcanfurtherreducetheriskofadverseeventscomparedtotheuseoffixedsedationprotocols.Finally,itemphasizestheuseofnon-pharmacologicalinterventions,suchasenvironmentalcontrolsandnursinginterventions,whichcanreducetheriskofdruginteractionsandsideeffects.

However,therearesomelimitationstotheeCASHstrategythatshouldbeconsidered.First,itrequiresspecializedtrainingandresources,includingdedicatedstaffandequipmentforreal-timemonitoringofsedationlevels.Second,itmaynotbesuitableforallpatientsorclinicalsettings,assomepatientsmayrequiredeepersedationoralternativeinterventions.Finally,thecost-effectivenessoftheeCASHstrategycomparedtotraditionalsedationpracticesisnotyetwell-established,andfurtherresearchisneededtoevaluateitseconomicimpact.

Inconclusion,theeCASHstrategyisapromisingapproachtopreventingdeliriuminICUpatientsreceivingmechanicalventilation.Itsusecanreducetheincidenceofdeliriumandimprovepatientoutcomeswhilepromotingpatientinvolvementandreducingtheriskofadverseevents.ImplementationoftheeCASHstrategyinICUsettingsmayrequirespecializedresourcesandtraining,butcanultimatelyimprovepatientsafetyandcomfort.FurtherresearchisneededtoevaluatetheeconomicimpactoftheeCASHstrategyanditsbroaderapplicabilitytodifferentpatientpopulationsandclinicalsettingsInadditiontoaddressingtheissueofdeliriuminICUpatients,theeCASHstrategycanalsohaveapositiveimpactonotherpatientoutcomes.Forexample,earlymobilization,whichisanimportantcomponentoftheeCASHstrategy,canhelppreventmuscleatrophyandweakness,reducetheriskofpressureulcers,andimproveoverallphysicalfunctioning.Similarly,involvingpatientsintheirowncarecanpromotepatientempowermentandimprovepsychologicalwell-being.

ImplementationoftheeCASHstrategymayrequireresourcesandtraining,butthepotentialbenefitstopatientsandthehealthcaresystemasawholemakeitworthconsidering.InordertosuccessfullyimplementtheeCASHstrategy,hospitalsmayneedtoinvestinadditionalstaffing,equipment,andinfrastructure.Forexample,hospitalsmayneedtoestablishdedicatedmobilityteams,purchasespecializedequipmentsuchasliftsorexercisemachines,ordeveloppoliciesandprocedurestosupportpatientinvolvement.

Inaddition,trainingforhealthcareprovidersmaybenecessarytoensurethattheyareequippedtoeffectivelyimplementtheeCASHstrategy.Thiscouldincludetrainingoncommunicationtechniquestosupportpatientinvolvement,aswellastrainingonthesafeandappropriateuseofequipmentforearlymobilization.

DespitethepotentialbenefitsoftheeCASHstrategy,therearesomechallengestoimplementingitinclinicalsettings.Forexample,healthcareprovidersmayhaveconcernsaboutthefeasibilityandsafetyofearlymobilization,particularlyforpatientswhoarecriticallyillorhavecomplexmedicalconditions.Inaddition,theremaybelogisticalchallengestoimplementingtheeCASHstrategy,suchaslimitedphysicalspaceintheICUorschedulingconflictswithotherclinicalactivities.

Toovercomethesechallenges,hospitalsmayneedtotakeaphasedapproachtoimplementingtheeCASHstrategy,startingwithapilotprogramtotestthefeasibilityandsafetyofearlymobilizationandpatientinvolvement.Thiscouldinvolveselectingasmallgroupofpatientswhoareappropriatefortheinterventionandprovidingextraresourcesandsupporttoensurethattheinterventionissuccessful.

Inconclusion,theeCASHstrategyisapromisingapproachforimprovingpatientoutcomesintheICU,particularlywithregardtoreducingtheincidenceofdeliriumandpromotingpatientinvolvement.Whileimplementationma