Monitoring sedation in critically ill patients

Hernández-Gancedo, C.; Pestaña, David; Peña, Natalia; Royo, C.; Pérez‐Chrzanowska, Hanna; Criado, A.

doi:10.1017/s0265021506000056

Cited by 45 publications

(11 citation statements)

References 24 publications

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“…Sedation requirements obviously differ among patients; nevertheless, the variation in recommended ranges in included studies indicates some uncertainty in what constitutes optimal sedation. Of the studies using the Ramsay scale, recommended ranges were 2 to 3 (recommended in two studies [21,22]), 2 to 4 (two studies [23,24]), 2 to 5 (two studies [25,26]), 3 to 4 (two studies [27,28]) and 4 to 5 (one study [29]), while three studies did not recommend specific levels but recommended that levels be optimised for each individual patient [30-32]. This variation was reflected in the other scales used; for studies recommending a modified Ramsay scale, recommended ranges were 1 to 4 [33], 3 to 4 [34], 4 [35], and 5 to 6 (the last range being specifically for seriously injured patients [36]) or targets optimised for each patient [37,38].…”

Section: Resultsmentioning

confidence: 99%

The incidence of sub-optimal sedation in the ICU: a systematic review

Jackson¹,

Proudfoot²,

Cann³

et al. 2009

Crit Care

116

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IntroductionPatients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs.MethodsWe searched Medline, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) online literature databases from 1988 to 15 May 2008 and hand-searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the incidence of sub-optimal sedation, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full papers of all included studies were retrieved and were again reviewed twice against inclusion criteria. Data were doubly extracted. Study aims, design, population, comparisons made, and data on the incidence of sub-optimal, optimal, over-sedation or under-sedation were extracted.ResultsThere was considerable variation between included studies in the definition of optimal sedation and in the scale or method used to assess sedation. Across all included studies, a substantial incidence of sub-optimal sedation was reported, with a greater tendency toward over-sedation.ConclusionsOur review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU.

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Section: Resultsmentioning

confidence: 99%

The incidence of sub-optimal sedation in the ICU: a systematic review

Jackson¹,

Proudfoot²,

Cann³

et al. 2009

Crit Care

116

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“…OAA/S is a validated clinical measure of sedation level. 15,16 In using the OAA/S assessment, we also hope to generalize our results to settings where bispectral index monitor is unavailable in the operating room.…”

Section: Discussionmentioning

confidence: 81%

“…15 More importantly, previous studies have shown that OAA/S score is better indicator of the level of sedation than electroencephalography. 15,16 …”

Section: Resultsmentioning

confidence: 99%

“…Our approach allows future comparison of the bispectral index data and OAA/S scores recorded intraoperatively. 16 …”

Section: Resultsmentioning

confidence: 99%

“…Cognition tests: Mini Mental State Examination, 15 Abbreviated Digit Span Test, 16 Informant Questionnaire on Cognitive Decline in the Elderly, 17 as well as testing of attention. DRS-R-98 (Delirium Rating Scale Revised 98)…”

Section: Figurementioning

confidence: 99%

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Design considerations of a randomized controlled trial of sedation level during hip fracture repair surgery: a strategy to reduce the incidence of postoperative delirium in elderly patients

Wieland

et al. 2017

Clinical Trials

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Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial “A Strategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients”(STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial. Methods Discussed are challenges encountered including (1) how to ensure that we quickly identify, assess the eligibility of, and randomize traumatic hip fracture patients; (2) how to implement interventions that involve continuous monitoring and adjustment during the surgery; and (3) how to measure and ascertain the primary outcome, delirium. Results To address the first challenge, we monitored the operating room schedule more actively than anticipated. We constructed and organized eligibility assessment data collection forms by purpose and by source of information needed to complete them. We decided that randomization needs to take place in the operating room. To address the second challenge, we designed and implemented a treatment protocol, and covered the bispectral index monitor to prevent the Anesthesiologists/Anesthetists from being influenced by the bispectral index reading while administering the intervention. Finally, clinical assessment of delirium consisted of standardized interviews of the patient using validated instruments, interviews of those caring for the patient, and review of the medical record. A consensus panel made the final determination of a delirium diagnosis. We note that STRIDE is a single-center trial. The decisions we took may have different implications for multi-center trials. Conclusions Lessons learned are likely to provide useful information to others designing trials in emergency and surgical setting, and for those who are interested in unbiased assessment of delirium.

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