Optimizing sedation in the ICU: the eCASH concept

Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept is a threepronged approach to minimize sedation in ICU patients by ensuring adequate and timely analgesia is received; patient-centred care is encouraged, including communication aids, noise reduction to facilitate good sleep patterns, early mobilization, and family involvement; and, when needed, sedation is targeted to individual needs and regularly reassessed, with patients kept calm, comfortable and able to cooperate.