ReviewIntensive care medicine2016
Comfort and patient-centred care without excessive sedation: the eCASH concept.
Review in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 154 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Southern Medical University Clinical Research Project Initiative：Efficacy and Safety of a Multicomponent Physical Therapy Program in Mechanically Ventilated Patient With Sepsis
Epidemiology of Weaning From Invasive Mechanical Ventilation in COVID-19. Observational and Multicenter Study.
Who cites it
154 citing papers in PubMed, 4 syntheses or guidelines pooled it, 413 citations in OpenAlex.
- Pooled it
- Comparison between remifentanil and other opioids in adult critically ill patients: A systematic review and meta-analysis.Medicine · 2021Pooled it
- Different depths of sedation versus risk of delirium in adult mechanically ventilated patients: A systematic review and meta-analysis.PloS one · 2020Pooled it
- The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis.Intensive care medicine · 2019Pooled it
- Alpha2 agonists for sedation to produce better outcomes for adults with critical illness: a synopsis of the A2B RCT with cost-effectiveness and process evaluation.Health technology assessment (Winchester, England) · 2026Trial
- Protocol for a multicenter, randomized, single-blind, non-inferiority trial comparing nalbuphine hydrochloride versus hydromorphone hydrochloride for analgesia in mechanically ventilated ICU patients.Frontiers in pharmacology · 2026Trial
- Sedative and Analgesic Drug Rotation Protocol Versus Non-Rotation Protocol in Mechanically Ventilated Children: A Randomised Controlled Trial.Indian journal of pediatrics · 2025Trial
- Effects of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics in pediatric patients undergoing laparoscopic inguinal hernia repair.BMC anesthesiology · 2025Trial
- Comparison of oxycodone hydrochloride and flurbiprofen axetil on analgesia in mechanically ventilated patients with respiratory failure in a multicenter study.Scientific reports · 2025Trial
- Effects of Esketamine Versus Remifentanil on Hemodynamics and Prognosis in Patients with Septic Shock Receiving Invasive Mechanical Ventilation: A Randomized Controlled Trial.Drug design, development and therapy · 2025Trial
- Sleep quality and quantity determined by polysomnography in mechanically ventilated critically ill patients randomized to dexmedetomidine or placebo.Acta anaesthesiologica Scandinavica · 2023Trial
- Prediction model for delirium in patients with cardiovascular surgery: development and validation.Journal of cardiothoracic surgery · 2022Trial
- Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation).Critical care (London, England) · 2022Trial
- Vomiting Management and Effect Prediction after Early Chemotherapy of Lung Cancer with Diffusion-Weighted Imaging under Artificial Intelligence Algorithm and Comfort Care Intervention.Computational and mathematical methods in medicine · 2022Trial
- Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study.PloS one · 2020Trial
- Enteral versus intravenous approach for the sedation of critically ill patients: a randomized and controlled trial.Critical care (London, England) · 2019Trial
- [Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit].Zhongguo dang dai er ke za zhi = Chinese journal of contemporary pediatrics · 2017Trial
- Spontaneous breathing for managing analgesia during balanced anesthesia with remifentanil and desflurane: a prospective, single center randomized controlled trial.Medical gas researchTrial
- Application of a flexible visitation system in critically ill patients: A randomized clinical trial.Science progressTrial
- Acute Pain During Intensive Care: Prevalence, Predisposing Factors and Pain Trajectories. A Prospective Multicenter Observational Study.Acta anaesthesiologica Scandinavica · 2026Observational
94 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
14 authors at 14 institutions in 12 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.