Evaluating the Effectiveness of Nurse-Led Early Comfort Using Analgesia, Minimal Sedatives, and Maximal Humane Care Sedation in Mechanically Ventilated Patients.

Abstract

Aims/Background 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. Methods 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. Results The observation group received a significantly higher dose of fentanyl within the first 24 hours of mechanical ventilation compared to the control group (p = 0.001). However, there was no significant difference in fentanyl use at 48 and 72 hours between the two groups (p > 0.05). Dexmedetomidine use in the observation group was significantly lower than in the control group at 24, 48, and 72 hours (p < 0.05). Moreover, no significant difference was observed in the use of propofol between the two groups (p > 0.05). The observation group had a significantly higher analgesia success rate within 72 hours (p = 0.027), although the sedation success rate was not significantly different (p > 0.05). Both groups showed significant improvement over time in Richmond Agitation-Sedation Scale (RASS) and Critical-Care Pain Observation Tool (CPOT) scores (p < 0.001), with the observation group demonstrating a significantly faster improvement in analgesia effectiveness compared to the control group (p = 0.015). The duration of mechanical ventilation was significantly shorter in the observation group (p = 0.011), while the incidence of delirium was lower but not statistically significant (p = 0.519). Additionally, there were no statistically significant differences in ICU stay duration and length of hospital stay between the two groups (p > 0.05). Conclusion 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.