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.

  1. Delirium screening (with CAM-ICU or ICDSC), prevention and early intervention with non-pharmacologic protocol, by stopping deliriogenic drugs, considering antipsychotics.
  2. Communication strategies:
  1. Reorientation strategies:
  1. Patient mobilization and early physiotherapy, avoid neuromuscular blocking agents.
  2. Physiological sleep promotion:
  1. ICU environment (indirect lights, beds towards sunlight, alarms without noise, preferred music availability).
  2. End-of-life decisions and cares (brochure, meeting with relatives, psychologist’s availability).
  3. Early joining of energy target, early normoglycemia, early enteral nutrition, early nutrition by mouth.


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