A Study of Correlation between Ramsay “Sedation Level” Scale and Richmond “Agitation–Sedation” Scale and Physiological Parameters to Determine the Need for Sedation in Patients Undergoing Mechanical Ventilation, 2013

2014 ◽  
Vol 11 (2) ◽  
pp. 621-626
Author(s):  
Marzieh Seidabady ◽  
Malahat Nikravan Mofrad ◽  
Farid Zayeri
Keyword(s):  
Mechanical Ventilation ◽  
Physiological Parameters ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Sedation Level ◽  
Level Scale

scholarly journals Responsiveness Index versus the RASS-Based Method for Adjusting Sedation in Critically Ill Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Johanna E. Wennervirta ◽  
Mika O. K. Särkelä ◽  
Markus M. Kaila ◽  
Ville Pettilä
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Deep Sedation ◽  
Adverse Outcomes ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Sedation Level ◽  
Intensive Care Patients ◽  
Responsiveness Index ◽  
Larger Sample

Background. Sedation of intensive care patients is needed for patient safety, but deep sedation is associated with adverse outcomes. Frontal electromyogram-based Responsiveness Index (RI) aims to quantify the level of sedation and is scaled 0–100 (low index indicates deep sedation). We compared RI-based sedation to Richmond Agitation-Sedation Scale- (RASS-) based sedation. Our hypothesis was that RI-controlled sedation would be associated with increased total time alive without mechanical ventilation at 30 days without an increased number of adverse events. Methods. 32 critically ill adult patients with mechanical ventilation and administration of sedation were randomized to either RI- or RASS-guided sedation. Patients received propofol and oxycodone, if possible. The following standardized sedation protocol was utilized in both groups to achieve the predetermined target sedation level: either RI 40–80 (RI group) or RASS −3 to 0 (RASS group). RI measurement was blinded in the RASS group, and the RI group was blinded to RASS assessments. State Entropy (SE) values were registered in both groups. Results. RI and RASS groups did not differ in total time alive in 30 days without mechanical ventilation ( p = 0.72 ). The incidence of at least one sedation-related adverse event did not differ between the groups. Hypertension was more common in the RI group ( p = 0.01 ). RI group patients were in the target RI level 22% of the time and RASS group patients had 57% of scores within the target RASS level. The RI group spent significantly more time in their target sedation level than the RASS group spent in the corresponding RI level ( p = 0.03 ). No difference was observed between the groups ( p = 0.13 ) in the corresponding analysis for RASS. Propofol and oxycodone were administered at higher RI and SE values and lower RASS values in the RI group than in the RASS group. Conclusion. Further studies with a larger sample size are warranted to scrutinize the optimal RI level during different phases of critical illness.

scholarly journals Remifentanil provides an increased proportion of time under light sedation than fentanyl when combined with dexmedetomidine for mechanical ventilation

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110026
Author(s):  
Yoshitaka Aoki ◽  
Takuya Niwa ◽  
Yuki Shiko ◽  
Yohei Kawasaki ◽  
Soichiro Mimuro ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Primary Outcome ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Percentage Points ◽  
The Mean ◽  
Light Sedation ◽  
Fentanyl Administration ◽  
Fentanyl Group ◽  
Remifentanil Group

Objective To compare the effects of remifentanil versus fentanyl during light sedation with dexmedetomidine in adults receiving mechanical ventilation (MV) in the intensive care unit. Methods In this retrospective cohort study, we compared the use of remifentanil versus fentanyl in adults receiving MV with dexmedetomidine sedation. The primary outcome was the proportion of time under light sedation (Richmond Agitation–Sedation Scale score between −1 and 0) during MV. Results We included 94 patients and classified 58 into the remifentanil group and 36 into the fentanyl group. The mean proportion of time under light sedation during MV was 66.6% ± 18.5% in the remifentanil group and 39.9% ± 27.3% in the fentanyl group. In the multivariate analysis with control for confounding factors, patients in the remifentanil group showed a significantly higher proportion of time under light sedation than patients in the fentanyl group (mean difference: 24.3 percentage points; 95% confidence interval: 12.9–35.8). Conclusions Remifentanil use might increase the proportion of time under light sedation in patients receiving MV compared with fentanyl administration.

Implementing the ABCDE Bundle, Critical-Care Pain Observation Tool, and Richmond Agitation-Sedation Scale to Reduce Ventilation Time

2020 ◽  
Vol 31 (1) ◽  
pp. 16-21
Author(s):  
Jennifer Bardwell ◽  
Sushama Brimmer ◽  
Wesley Davis
Keyword(s):  
Critical Care ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Evidence Based ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Early Mobility ◽  
Ventilation Time ◽  
The Awakening ◽  
Abcde Bundle

Prolonged mechanical ventilation of patients in intensive care units across the United States consumes billions of health care dollars every year. Using the awakening and breathing coordination, delirium monitoring/management, and early mobility (ABCDE) bundle along with the Critical-Care Pain Observation Tool and the Richmond Agitation-Sedation Scale combines the best available evidence to optimize outcomes for critically ill patients. This study is the first to examine the effects of implementing the ABCDE bundle, the Critical-Care Pain Observation Tool, and the Richmond Agitation-Sedation Scale together in a coordinated effort across multiple disciplines. The aim of using this combination of evidence-based tools is to reduce ventilation time by reducing oversedation, decreasing the incidence of delirium, and improving pain management.

Ramsay Sedation Scale and Richmond Agitation Sedation Scale

2019 ◽  
Vol 38 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Akram M. Rasheed ◽  
Mohammad F. Amirah ◽  
Mohammad Abdallah ◽  
Parameaswari P.J. ◽  
Marwan Issa ◽  
...  
Keyword(s):  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Ramsay Sedation Scale

Übersetzungsverfahren eines klinischen Assessmentinstrumentes am Beispiel der Richmond Agitation-Sedation Scale (RASS)

Pflege ◽  
2009 ◽  
Vol 22 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Ursi Barandun Schäfer ◽  
Paola Massarotto ◽  
Angelika Lehmann ◽  
Christoph Wehrmüller ◽  
Rebecca Spirig ◽  
...  
Keyword(s):  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Deutschsprachige Version

Patientinnen und Patienten von Intensivstationen werden sediert, um die Belastungen durch Erkrankung und/oder Behandlung zu reduzieren. Zur Vermeidung inadäquater Sedationstiefe und ihrer negativen Folgen wird die regelmäßige Erfassung der Sedationstiefe als Teil der zielorientierten Sedationspraxis empfohlen. Die Schweizerische Gesellschaft für Intensivmedizin verlangt von den anerkannten Intensivstationen die regelmäßige Dokumentation des Sedationsscores als festen Bestandteil des Minimalen Datensatzes (MDSi). Eine der beiden vorgeschlagenen Skalen für die Einschätzung der Sedation ist die zehnstufige Richmond Agitation-Sedation Scale (RASS). Da bisher keine validierte deutschsprachige Version vorliegt, wurde die englische Skala mittels systematischen Vorgehens in sechs Schritten ins Deutsche übersetzt. Im vorliegenden Artikel wird die Übersetzung der RASS für die Anwendung in der Deutschschweiz als Beispiel eines multiprofessionellen Übersetzungsprozesses beschrieben. Der Übersetzung von Instrumenten für den klinischen Gebrauch sollte ebenso viel Sorgfalt zukommen wie bei der Entwicklung von Forschungsinstrumenten. Es werden folgende Empfehlungen abgeleitet: a) Berücksichtigung von Fachliteratur nicht lediglich zum Gegenstand der Übersetzung, sondern auch zum geeigneten Vorgehen beim Übersetzen, b) Einbezug professioneller Übersetzerinnen und Übersetzer als sprachliche Expertise sowie c) Rücksprachen mit den Autoren und Autorinnen der Originalfassung.

scholarly journals Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU)

2021 ◽  
Author(s):  
Björn Weiss ◽  
Nicolas Paul ◽  
Claudia D. Spies ◽  
Dennis Ullrich ◽  
Ingrid Ansorge ◽  
...  
Keyword(s):  
Neurocritical Care ◽  
Test Validity ◽  
Repeated Measurements ◽  
Receiver Operating Characteristics ◽  
Patient Specific ◽  
Operating Characteristics ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Dsm Iv ◽  
Neurosurgical Intervention

Abstract Background Delirium screening instruments (DSIs) should be used to detect delirium, but they only show moderate sensitivity in patients with neurocritical illness. We explored whether, for these patients, DSI validity is impacted by patient-specific covariates. Methods Data were prospectively collected in a single-center quality improvement project. Patients were screened for delirium once daily using the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Reference was the daily assessment using criteria from the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR). In a two-step receiver operating characteristics regression analysis adjusting for repeated measurements, the impact of acute diagnosis of stroke or transient ischemic attack (TIA), neurosurgical intervention, Richmond Agitation Sedation Scale, and ventilation status on test validity was determined. Results Of 181 patients screened, 101 went into final analysis. Delirium incidence according to DSM-IV-TR was 29.7%. For the first complete assessment series (CAM-ICU, ICDSC, and DSM-IV-TR), sensitivity for the CAM-ICU and the ICDSC was 73.3% and 66.7%, and specificity was 91.8% and 94.1%, respectively. Consideration of daily repeated measurements increased sensitivity for the CAM-ICU and ICDSC to 75.7% and 73.4%, and specificity to 97.3% and 98.9%, respectively. Receiver operating characteristics regression revealed that lower Richmond Agitation Sedation Scale levels significantly impaired validity of the ICDSC (p = 0.029) and the CAM-ICU in its severity scale version (p = 0.004). Neither acute diagnosis of stroke or TIA nor neurosurgical intervention or mechanical ventilation significantly influenced DSI validity. Conclusions The CAM-ICU and ICDSC perform well in patients requiring neurocritical care, regardless of the presence of acute stroke, TIA, or neurosurgical interventions. Yet, even very light or moderate sedation can significantly impair DSI performance.

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