Appropriateness and Reliability Testing of the Modified Richmond Agitation-Sedation Scale in Spanish Patients With Advanced Cancer

Benítez-Rosario, Miguel Ángel; Castillo-Padrós, Manuel; Garrido-Bernet, Belen; González-Guillermo, Toribio; Martínez-Castillo, Luis Pedro; González, Aceysele

doi:10.1016/j.jpainsymman.2012.05.015

Cited by 37 publications

(39 citation statements)

References 23 publications

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“…Moreover, the GCS shows excellent correlation and discrimination with the RASS ( r = 0.91, P < 0.001), as described by Ely and colleagues from 1,360 paired observations among 275 adult patients in medical and coronary ICUs [25]. This strong correlation between the RASS and the GCS was also shown in other sedation scale validation studies [42,43], which allows its applicability as a surrogate for sedation depth in the present study.…”

Section: Discussionsupporting

confidence: 85%

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

et al. 2014

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IntroductionSedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).MethodsA secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.ResultsA total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality.ConclusionsEarly deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.

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Section: Discussionsupporting

confidence: 85%

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

et al. 2014

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“…It should be noted that the original RASS instrument provides a snapshot measure of "agitation," as opposed to being a formal screening assessment for "agitated delirium." Although the RASS is currently used in many palliative care settings (90,96,113,114), there are few reports examining the reliability of modified versions in patients with advanced cancer (115). A version of the RASS modified for palliative care inpatients, the RASS-PAL, demonstrated high inter-rater reliability in a recent pilot study (116).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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“…Brinkkemper et al [91 ▪ ] examined the availability of suitable tools for the appropriate monitoring of palliative sedation by the interprofessional team. A modified Spanish version of the RASS, originally validated in intensive care patients, was developed for the assessment of Spanish patients with advanced cancer [92]. In this study, 38 (24%) of the 156 patients admitted to the palliative care unit were receiving palliative sedation and 57 (37%) had delirium.…”

Section: Palliative Sedationmentioning

confidence: 99%

“…The inter-rater intraclass correlation coefficient range of the RASS-PAL for the five assessment time points was 0.84–0.98. Training in the appropriate use of these instruments is essential, especially for nonexperienced staff [92,93]. …”

Section: Palliative Sedationmentioning

confidence: 99%

Delirium diagnosis, screening and management

Lawlor

Bush

2014

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewOur review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care.Recent findingsDelirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation.SummaryAlthough formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.

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Appropriateness and Reliability Testing of the Modified Richmond Agitation-Sedation Scale in Spanish Patients With Advanced Cancer

Abstract: These data support the use of the RASS in Spanish patients with advanced cancer.

Cited by 37 publications

References 23 publications

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Delirium diagnosis, screening and management

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