eCASH and Early Goal-Directed Mobilization to Prevent ICU-Acquired Weakness

The First Affiliated Hospital of Soochow University70 enrolled

Overview

This single-center, prospective, randomized controlled trial aims to evaluate whether an eCASH concept-based analgesia and sedation strategy combined with early goal-directed mobilization can reduce the incidence of intensive care unit-acquired weakness (ICU-AW) in mechanically ventilated ICU patients. A total of 70 adult patients receiving invasive mechanical ventilation will be randomly assigned in a 1:1 ratio to either the intervention group or the control group. The intervention group will receive routine ICU nursing care plus an eCASH-based analgesia and sedation strategy combined with early goal-directed mobilization, while the control group will receive routine ICU nursing care. The primary outcome is the incidence of ICU-AW. Secondary outcomes include total doses of remifentanil and midazolam, respiratory function after extubation, duration of mechanical ventilation, and adverse events.

Intensive care unit-acquired weakness (ICU-AW) is a common complication in critically ill patients receiving invasive mechanical ventilation. It may prolong mechanical ventilation, delay recovery, increase the risk of complications, and impair long-term functional outcomes. Both optimized analgesia-sedation management and early mobilization are considered important strategies for reducing ICU-AW, but evidence regarding their combined application remains limited. This study is a single-center, prospective, randomized, parallel-group, single-blind controlled trial. Eligible adult ICU patients receiving invasive mechanical ventilation will be randomly assigned to either the intervention group or the control group. The control group will receive routine ICU nursing care, including routine analgesia and sedation management, vital sign monitoring, airway care, skin care, psychological support, muscle strength assessment, and early activity after clinical stabilization. The intervention group will receive routine ICU nursing care plus an eCASH concept-based analgesia and sedation strategy combined with early goal-directed mobilization. The eCASH-based strategy emphasizes early combined intervention, patient comfort, analgesia-first management, minimization of sedative exposure, and humanistic care. A multidisciplinary team will assess each patient and develop individualized analgesia, sedation, comfort, and rehabilitation plans. Early goal-directed mobilization will be adjusted according to the patient's clinical condition, functional status, and tolerance, and may include passive or active limb exercises, balance training, bedside cycling exercise, and transcutaneous electrical stimulation. The intervention will begin after enrollment in the ICU and continue until transfer out of the ICU. Outcome assessors and statistical analysts will be blinded to group allocation. The study aims to determine whether the combined eCASH and early goal-directed mobilization strategy can reduce the incidence of ICU-AW and improve respiratory and clinical recovery in mechanically ventilated ICU patients.

Interventions

eCASH-Based Analgesia and Sedation Strategy Combined With Early Goal-Directed MobilizationBEHAVIORAL

This intervention consists of routine ICU nursing care plus an eCASH concept-based analgesia and sedation strategy combined with early goal-directed mobilization. The eCASH strategy includes early combined intervention, promotion of patient comfort, analgesia-first management, minimization of sedative exposure, and humanistic care. Early goal-directed mobilization is individualized according to the patient's clinical condition, functional status, and tolerance, and may include passive or active limb exercises, balance training, bedside cycling exercise, and transcutaneous electrical stimulation.

Routine ICU Nursing CareBEHAVIORAL

Routine ICU nursing care includes routine analgesia and sedation management, monitoring of vital signs, assessment of consciousness and analgesia/sedation status, feedback to the attending physician for medication adjustment, muscle strength assessment, regular turning, sputum suction, airway and tube care, skin care, psychological support, and early activity after clinical stabilization.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients admitted to the ICU who require invasive mechanical ventilation and have a mechanical ventilation duration of at least 48 hours. * Age 18 years or older. * Patients who are not undergoing secondary intubation. * Patients with relatively stable organ function. * Written informed consent provided by the patient's family member or legally authorized representative. Exclusion Criteria: * Patients in the acute stress phase with hemodynamic instability, including severe patient-ventilator asynchrony, severe traumatic brain injury with intracranial hypertension, status epilepticus, or after cardiopulmonary resuscitation. * Patients with severe acute respiratory distress syndrome. * Patients with neurological diseases, organic neurological lesions, or neurological injury. * Patients with a history of psychiatric disease. * Patients with complications causing altered mental status and inability to cooperate, such as hepatic encephalopathy or pulmonary encephalopathy. * Patients diagnosed with myasthenia gravis. * Patients with a history of psychoactive drug abuse, illicit drug use, or alcohol abuse.

Outcomes

Primary Outcomes

Incidence of ICU-Acquired Weakness

ICU-acquired weakness will be assessed using the Medical Research Council muscle strength score. Six bilateral muscle groups will be evaluated, including shoulder abduction, elbow flexion, wrist extension, hip flexion, knee extension, and ankle dorsiflexion. A total score of less than 48 will be considered diagnostic of ICU-acquired weakness.

Time frame: At transfer out of the ICU

Secondary Outcomes

Total Dose of Remifentanil

The total amount of remifentanil administered during the ICU intervention period will be recorded and compared between the two groups.

Time frame: From enrollment to transfer out of the ICU, assessed up to 6 months

Total Dose of Midazolam

The total amount of midazolam administered during the ICU intervention period will be recorded and compared between the two groups.

Time frame: From enrollment to transfer out of the ICU, assessed up to 6 months

Forced Vital Capacity After Extubation

Forced vital capacity will be assessed after extubation to evaluate respiratory function recovery. A higher value indicates better respiratory function.

Time frame: Within 24 hours after extubation

Peak Expiratory Flow After Extubation

Peak expiratory flow will be assessed after extubation to evaluate respiratory function recovery. A higher value indicates better respiratory function.

Time frame: Within 24 hours after extubation

Duration of Mechanical Ventilation

The duration of mechanical ventilation will be obtained from medical orders and nursing records, calculated from the start to the end of mechanical ventilation.

Time frame: From initiation of mechanical ventilation to successful discontinuation, assessed up to 6 months