Effectiveness And Safety Of ECash In Preventing Delirium In Patients With Mechanical Ventilation In ICU

Objectives:1.To explore the application effect of eCASH(early Comfort using Analgesia,minimal Sedatives and maximal Humane care)in patients with mechanical ventilation in ICU.2.To evaluate effectiveness and safety of the eCASH in preventing delirium with mechanical ventilation in ICU.Methods:This study is a prospective study,selected 4 adult critical medicine departments in A general hospital in Fujian Province as the research site.60 patients were selected as the control group,using conventional care mode + conventional analgesia and sedation care;62 patients were selected as the intervention group,based on the conventional care model,using eCASH + goal-oriented analgesia and sedation care.To compare the incidence of delirium,the incidence of ICU-acquired weakness,the duration of mechanical ventilation,the ICU length of stay,the duration of delirium,the satisfaction of nursing services,and the incidence of adverse events in the two groups.The two groups of patients used BI(Barthel Index),Caprini Risk Assessment Scale,and Braden Scale to assess their selfcare ability,venous thromboembolism risk,and pressure injury risk when entered and left ICU.Analyze the influence of eCASH on the prognosis of patients by comparing within and between groups.Rrecord the nurses during the study execution strategy compliance,delirium assessment compliance rate,goal-oriented light sedation days compliance rate,goal-oriented analgesia days compliance rate,number of patients off-bed activity.Statistical analysis was performed using IBM SPSS 24.0 statistical software,P <0.05 was considered statistically significant.Results:1.Baseline data comparison:in 2019.03-2019.10,a total of 225 patients in the research department met the enrollment criteria,115 in the control group,55 were rejected,110 in the intervention group,48 were rejected,60 were in the final control group,and62 were included in the intervention group.Statistical analysis: There was no statistically significant difference between the general and clinical data of the two groups,and the baseline data were comparable in distribution.2.Comparison of outcome indicators2.1 The incidence of delirium and ICU-acquired weakness in the intervention group were lower than those in the control group,the difference was statistically significant(P<0.05).The duration of delirium,duration of mechanical ventilation and ICU length of stay in the intervention group were all smaller than those in the control group,and the difference was statistically significant significance(P<0.05).The satisfaction of nursing services in the intervention group was greater than that of the control group,and the difference was statistically significant(P<0.05).The difference in the incidence of adverse events between the two groups was not statistically significant(P>0.05).2.2 Comparison of prognosis between the two groups of patients: BI,Caprini,and Braden scores of the two groups were not statistically significant when they were entered ICU(P>0.05);there were statistically significant differences in the scores when left ICU(P<0.05).The difference in BI scores between entered ICU and left ICU in the control group was statistically significant(P<0.05),and the differences in Caprini and Braden scores were not statistically significant(P>0.05).The differences in BI,Caprini,and Braden scores between entered ICU and left ICU in the intervention group were statistically significant(P <0.05).3.Comparison of process indicators for implementing eCASH: the compliance rate of nurses in the intervention group was 95.8%,there was no statistically significant difference between the two groups of nurses in delirium assessment compliance rate(P>0.05);the intervention group’s goal-oriented light sedation days and goal-oriented analgesia days ’compliance rates were greater than the control group,the difference was statistically significant(P<0.05);the number of people off-bed activity in the intervention group was greater than that in the control group,the difference was statistically significant P<0.05).Conclusion:The eCASH can reduce the incidence of delirium in patients with mechanical ventilation in ICU,shorten the duration of delirium,duration of mechanical ventilation and ICU length of stay;increase the muscle strength of patients with mechanical ventilation,reduce the incidence of ICU-acquired weakness;improve the self-care ability of patients with mechanical ventilation,reduce the risk of venous thromboembolism and pressure injury,and improve the prognosis of patients;improve the satisfaction of nursing service.In summary,the eCASH is safe and effective in preventing delirium in patients with mechanical ventilation in ICU.