Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária

Abstract

Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária Artigo originAl introDUCtion Most patients admitted to the pediatric intensive care unit (ICU) need sedation and analgesia to optimize treatment. Sedation lessens agitation and permits better synchronization with mechanical ventilation, reduces oxygen demand and controls anxiety or pain caused by disease or by the unit environment. (1) For an adequate assessment of the patient's sedation level, a practical, objective and easy to use tool is required. Although the clinical opinion of physicians and nurses is important, a scale application is required to estimate the neurophysiologic effects of sedatives and other interventions as well as to permit a comparison between samples of

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

“…4,33 The COM-FORT-B scale is also validated in Portuguese, with its use recommended. 34 The daily interruption is being used for a long time in adult ICUs, demonstrating benefits such as a 2.4-day decrease in mechanical ventilation (p=0.004) and a 3.5-day decrease in length of ICU stay (p=0.02), without increase in the number of complications. 3 Daily interruption of sedation has always been discussed in pediatric ICU because of technical difficulties when compared to adult practice, greater risk of adverse events, including accidental tracheal extubation, and loss of invasive devices.…”

Comparison between Comfort-Behavior and Ramsay scales in a pediatric intensive care unit

“…Analgesia and sedation, in addition to optimizing the treatment, provide comfort, control pain and decrease the level of anxiety and agitation of these patients 1,2 . Notwithstanding the benefits of vasoactive and analgesic drugs for critically ill patients, the excessive use is associated to increased hospitalization time, risk of infections and mortality rate, in addition to the probability of developing withdrawal symptoms when they are interrupted, which may vary in quality and intensity [1][2][3][4] . The use of sedation/analgesia should be carefully evaluated by the medical team by means of reached sedation levels, to use the lowest possible dose and minimize the risk of adverse events, giving priority to optimal sedation.…”

“…Deep sedation should only be maintained when needed, thus decreasing mechanical ventilation support time and consequently hospitalization costs. It is also recommended to avoid insufficient sedation which would cause distress to patients in addition to putting at risk their safety [1][2][3][4] . Current trend is toward tailoring patients' treatment, which makes critical the continuous evaluation of pain, the monitoring of sedation and analgesia.…”

“…This information helps them to daily redefine and adjust drug doses. Major scales currently being used are Ramsay sedation scale (R), Richmond sedation agitation scale and ComfortBehavior (CB) scale, being the former and the latter the most widely used in pediatrics [1][2][3][4] . It is possible to find in the literature comparisons between R and CB scales, showing equivalence in the evaluation of sedation levels of critically ill patients.…”

“…There is also a study analyzing CB scale and Motor Activity Evaluation scale (MAE) as a valid tool to be used in children submitted to MV. However, studies do not mention the time spent to apply such scales 2,3 . There are no studies in the literature specifically comparing R and CB scales.…”