Psyche revived by Cupid's kiss

H.E.R.O.I.C. bundle

Humanization to Enhance Recovery On Intensive Care

1. “Open ICU” and cooperation with relatives (communication, physiotherapy, nutrition, diaries, …).

2. Adequate analgesia ever (measured with VNR or BPS) together with light (conscious) sedation, measured with RASS or SAS,

within 48h from ICU admission and use of protocols, like “analgesia-first sedation”, use of dexmedetomidine, enteral approach with hydroxyzine,

daily interruption of continuous sedatives each morning and coordination with breathing trials.

3. Delirium screening (with CAM-ICU or ICDSC), prevention and early intervention with non-pharmacologic protocol, by stopping deliriogenic drugs, considering antipsychotics.
4. Communication strategies:

• towards patients (visual/hearing aids, calling by name, augmentative/alternative communication);
• towards relatives (brochures, website, meeting rules, direct explanations, psychologist’s availability).

5. Reorientation strategies:

• in-ICU (personal belongings, books/newspapers, pc/tablets, practical activities);
• post-ICU (ICU diaries made by health care team and relatives, follow-up after hospital discharge).

6. Patient mobilization and early physiotherapy, avoid neuromuscular blocking agents.
7. Physiological sleep promotion:

• days awake (music and TV, DVD player, discourage sleep during daytime);
• silent nights (lights off, noise control, avoid unnecessary procedures);
• melatonin supplementation.

8. ICU environment (indirect lights, beds towards sunlight, alarms without noise, preferred music availability).
9. End-of-life decisions and cares (brochure, meeting with relatives, psychologist’s availability).
10. Early joining of energy target, early normoglycemia, early enteral nutrition, early nutrition by mouth.

Website under construction, for more information: info@heroicbundle.org

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