The Study Of The Ecash Strategy For Preventing Delirium In Patients With Mechanical Ventilation In ICU

ObjectiveTo evaluate effect of eCASH(Early implementation,Comfortable cooperative and calm,Analgesia first,Sedatives mini-mized and targeted,Humane person/family-centred)strategy on delirium preventing among mechanically ventilated(MV)patients in Intensive Care Unit(ICU).The aim of this study is to promote the MV patients to achieve the target level of analgesia and sedation,improving the sleep quality of patients,reducing the dosage of analgesics and Sedatives,reducing the incidence of delirium and duration of delirium,in order to shorten the time of mechanical ventilation and ICU length of stay,and further improve the prognosis of patients.Methods1.This study adopted quasi experimental research method,Participants were selected from a convenience sample of 100 ICU patients with mechanical ventilation in a tertiary comprehensive hospital in Changsha,From October 2018 to March 2019.100 patients with mechanical ventilation were selected and divided into two groups(50 cases in the control group,50 cases in the intervention group)according to their admission order.Patients in the control group were given usual care,while patients in the intervention group received eCASH strategy.Richards Campbell Sleep Questionnaire(RSCQ)was used to judge the sleep quality of the patients,and the Chinese version of Confusion Assessment Method for the Intensive Care Unit(CAM-ICU)was used to assess whether delirium occurs or not.The dosage of analgesics and Sedatives,duration of delirium,delirium subtypes,duration of mechanical ventilation,ICU length of stay and outcome were recorded.2.The data was analyzed and processed by using SPSS 20.0.Results1.There was no significant difference in baseline data,such as gender,age,APACHEII score,primary diagnosis and education level between the two groups(P>0.05).The baseline data of the two groups were consistent and comparable.2.The sleep quality was improved in eCASH group after intervention.The RCSQ score of eCASH group was higher than that of control group(P<0.05),In eCASH group,the patients’ perception of sleep depth,times of awakening at night,total sleep time,ICU environmental noise intensity were higher than those in the control group(P<0.05).In eCASH group,the time of falling asleep at night and falling asleep again after awakening were higher than those in the control group,but the difference was not statistically significant(P>0.05).the Maximum noise by bed at night of eCASH group was lower than that of the control group,were had significant differences between the two groups(P<0.05),the Maximum daytime noise by bed of eCASH group was lower than that of the control group,but the difference was no statistically significant(P>0.05).3.The dose of Remifentanil in eCASH group was less than that in control group,but the difference was not statistically significant(P> 0.05).The dose of Midazolam in eCASH group was less than that in control group(P<0.05).The dose of Dexmedetomidine in eCASH group was less than that in control group,The difference between two group was statistically significant(P<0.05).4.The incidence of delirium of eCASH group were significant decreased compared with control group(P<0.05).5.There were no significant difference in delirium types(P>0.05).In the two groups,the type of hypoactive delirium were largest,followed bymixed type,and the type of hyperactive delirium was least.6.The mechanical ventilation time and ICU length of stay of eCASH group were significant decreased compared with control group(P<0.05).7.Compared with the prognosis of the two groups,the death/ abandonment rate of eCASH group were significant decreased compared with control group(P<0.05).Conclusion1.eCASH strategy improves the sleep quality of patients with mechanical ventilation.2.eCASH strategy can significantly reduces the dosage of sedative drugs of patients with mechanical ventilation.So it is beneficial for patients with mechanical ventilation to achieves the goal of analgesia and sedation.3.eCASH strategy effectively reduces the incidence of delirium and shorten the duration of delirium of patients with mechanical ventilation.4.eCASH strategy shortens the duration of mechanical ventilation and ICU stay time,and improves the prognosis of patients with mechanical ventilation.It has strong practicability and certain clinical popularization.