Stimulation of Critically Ill Patients: Relationship to Sedation

Grap, Mary Jo; Munro, Cindy L.; Wetzel, Paul A.; Ketchum, Jessica M.; Ketchum, James S.; Anderson, William L.; Best, Al M.; Hamilton, V. Anne; Arief, Nyimas Y.; Burk, Ruth S.; Bottoms, Tenesha; Sessler, Curtis N.

doi:10.4037/ajcc2016269

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…We found a significant correlation between the PSI and the RASS, which is expected and not surprising given that both methods are used for sedation depth measurement. The arousability by stimulation in the sedated ICU patients correlates with the depth of sedation, as measured with the RASS and expressed via the PSI [ 50 ]. Interestingly, a closer look reveals inconsistencies: the RASS does not adequately reflect the clinically observed depth of sedation.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, a closer look reveals inconsistencies: the RASS does not adequately reflect the clinically observed depth of sedation. The PSI values obtained indicated a much lower RASS (e.g., −5) than that determined in the clinical examination (−3/−4) [ 50 ]. Regarding the sedation of critically ill patients, there exists no consensus on the method to be used.…”

Section: Discussionmentioning

confidence: 99%

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Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (p < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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“…The selected sixty participants were randomly and equally allocated to either a control or an intervention group through block randomization [11]. Sampling conducted based on random block process by computer.…”

Section: Design and Participantsmentioning

confidence: 99%

“…Sensory stimulation is a therapeutic method which stimulates the reticular activating system in the brain and facilitates the reorganization of brain activities through creating new neural links [10]. Auditory stimulation is one of the sensory stimuli which can be provided to patients in ICU by their family members or nurses [11].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Familiar Voices on the Level of Consciousness among Comatose Patients: A Single-Blind Randomized Controlled Trial

Mohammadi

Yeganeh

Ebrahimzadeh

et al. 2019

JPRI

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Background: Brain injury can reduce consciousness and the ability to respond to environmental stimulation. Objectives: The aim of this study was to investigate the effects of familiar voices on the level of consciousness (LOC) among comatose patients with a brain injury hospitalized in the intensive care unit. Methods: In this randomized controlled trial, sixty comatose patients with head trauma were conveniently selected from an intensive care unit of a hospital in Rasht, Iran, and randomly allocated to either a control or an intervention group. Participants in the intervention group received auditory stimulation for three consecutive days and the level of consciousness was compared in two groups. The Glasgow Coma Scale was used to assess the patients’ level of consciousness. The data were analyzed through the Chi-square, the paired-samples t, student’s t test, and the repeated-measures analysis of variance. Results: A significant increase was found in the mean LOC in the intervention group after every daily auditory stimulation (P<0.05). However, no significant changes were observed in the control group (P>0.05). The repeated-measures analysis of variance revealed that the time and interaction of time and groups were statistically significant (P<0.001). Conclusion: Auditory stimulation with familiar voice was effective in improving levels of consciousness among comatose patients with a brain injury after three days.

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“…On the other hand, hearing is the most important sense for understanding peace and security and the last sense that disappears in comatose patients; unlike other senses, there is no obstacle to stimulate this sense (27). Grap et al (28) found that auditory stimulation affects the management of agitation. Administering the right sedation is one of the essential roles of nurses in relation to mechanically ventilated patients admitted to ICU (29).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Auditory and Tactile Stimulation by a Family Member on the Level of Agitation in Patients with Traumatic Brain Injury and Decreased Consciousness: A Quasi-Experimental Study

et al. 2020

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Background: Agitation in mechanically ventilated patients with decreased consciousness is a challenge in the ICU and a threat to the process of mechanical ventilation. On the other hand, controlling agitation through medication and imposing physical limitations is associated with a number of undesirable side effects. Objectives: This study aimed to determine the effect of auditory and tactile stimulation by a family member on the level of agitation in patients with traumatic brain injury (TBI) and decreased consciousness. Methods: This quasi-experimental study was performed on 80 TBI patients with decreased consciousness who were admitted to the ICU of two teaching hospitals in southeastern Iran in 2019. Qualified patients were selected by convenience sampling and then randomized into the intervention (n = 40) and control (n = 40) groups. Data collection tools included a demographic form and the Richmond Agitation and Sedation Scale (RASS). For patients in the intervention group, the researcher first completed the demographic form and the RASS. Then, they underwent the experiment, which consisted of auditory and sensory stimulation by a family member for 10 minutes. After 30 minutes, the agitation level was measured again. This experiment was performed for seven consecutive days between 16:00 and 18:00 o’clock. Patients in the control group, however, did not receive any intervention other than routine care in the ICU. Data were analyzed in SPSS version 21 by using descriptive statistical tests and independent t-test, paired t-test, [analysis of] covariance, and chi-square test at the significance level of P < 0.05. Results: The results indicated no significant difference in the level of agitation in the intervention and control groups between the first and fifth days; however, independent t-tests and analysis of covariance revealed that the patients who received auditory and tactile stimulation on the sixth and seventh days experienced significantly lower levels of agitation than the control group (P < 0.01). Conclusions: Auditory and tactile stimulation by family members is effective in decreasing the agitation of TBI patients with decreased consciousness. Therefore, it is suggested as a helpful intervention in nursing care programs.

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Stimulation of Critically Ill Patients: Relationship to Sedation

Cited by 5 publications

References 28 publications

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

The Effects of Familiar Voices on the Level of Consciousness among Comatose Patients: A Single-Blind Randomized Controlled Trial

The Effect of Auditory and Tactile Stimulation by a Family Member on the Level of Agitation in Patients with Traumatic Brain Injury and Decreased Consciousness: A Quasi-Experimental Study

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