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.

Sedation assessment in the critically ill

2016 ◽  
Author(s):  
Giovanni Mistraletti ◽  
Gaetano Iapichino
Keyword(s):  
Critically Ill ◽  
Gold Standard ◽  
Interobserver Variability ◽  
Deep Sedation ◽  
Good Clinical Practice ◽  
Patient Comfort ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Time Required ◽  
The Ideal

Patient comfort is a primary goal in ICU, but achieving and maintaining the appropriate balance of analgesia, sedation, and treatment of delirium is frequently challenging. International guidelines recommend keeping critically-ill patients calm and cooperative, awake in daytime and asleep at night, always avoiding deep sedation. To state the actual level of sedation and the desired one, it is necessary to frequently perform a sedation assessment with validated tools. Subjective methods are the most useful guides in ICU consciously-sedated patients, representing the gold standard for good clinical practice. Use of such a scale is a key component of sedation algorithms. The ideal scoring system should be easy, reliable, sensitive, and with minimal interobserver variability, giving no or minimal additional discomfort to the patient. Most of the proposed tools are a compromise between accuracy and time required for evaluation; the most used are the Richmond Agitation-Sedation Scale and the Sedation-Agitation Scale.

scholarly journals Effects of deep sedation on sleep in critically ill medical patients on mechanical ventilation

2019 ◽  
Vol 29 (3) ◽  
Author(s):  
Raymonde Jean ◽  
Purav Shah ◽  
Eric Yudelevich ◽  
Frank Genese ◽  
Katherine Gershner ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Deep Sedation ◽  
Medical Patients

scholarly journals Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Abigail Glicksman Kerson ◽  
Rebecca DeMaria ◽  
Elizabeth Mauer ◽  
Christine Joyce ◽  
Linda M. Gerber ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Children ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale

Trends in the use of sedatives, opioids, and neuromuscular blockers in critically ill patients during the COVID-19 pandemic v1

2021 ◽  
Author(s):  
Jorge not provided Machado Alba
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Service Providers ◽  
Deep Sedation ◽  
Anesthetic Induction ◽  
State Institutions ◽  
Neuromuscular Blockers ◽  
Rapid Changes

Trends in the use of sedatives, opioids, and neuromuscular blockers in critically ill patients during the COVID-19 pandemic Introduction: The coronavirus disease 2019 (COVID-19) pandemic has increased the use of drugs administered for mechanical ventilation, leading to shortages in some countries. The objective was to identify trends in the consumption of sedatives, hypnotics, neuromuscular blockers, and opioids used for anesthetic induction and deep sedation in hospitals in Colombia. Method: This was a descriptive, longitudinal, and retrospective study with monthly follow-up of dispensations of sedatives, hypnotics, opioids, and neuromuscular blockers in 20 clinics and hospitals from January to November 2020. The frequencies of use of each drug and variations in the institutions and intensive care units (ICUs) were identified. Results: A total of 1,252,576 units of the analyzed drugs were delivered to 79,094 treated patients, 55.0% of whom were women (n=43,521). The drugs with the greatest increase in consumption were rocuronium (1.058% variation in March-November) and propofol (511%). The final consumption of midazolam and vecuronium decreased.Among dispensations made only in ICUs, 920,170 units were delivered (73.5% of the drugs dispensed during the study), and the most often dispensed drugs were fentanyl (n=251,519; 27.3% of the drugs used in the ICU) and midazolam (5mg/5mL) solution (n=188,568; 20.5%). Specifically in the ICU, the drugs with the greatest increase in use were rocuronium (19.709%), propofol (2.622%), and ketamine (2.591%). Conclusion: Rapid changes in the use of drugs were evident, which demonstrates the need for closer cooperation among treating physicians, service providers, pharmaceutical managers, and state institutions to maintain a sufficient and timely supply of critical drugs in this type of contingency.

scholarly journals Identification of delirium and subsyndromal delirium in intensive care patients

2019 ◽  
Vol 72 (2) ◽  
pp. 463-467
Author(s):  
Alessandra Soler Bastos ◽  
Lúcia Marinilza Beccaria ◽  
Daniele Cristiny da Silva ◽  
Taís Pagliuco Barbosa
Keyword(s):  
Intensive Care ◽  
Length Of Hospital Stay ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Chi Square ◽  
Intensive Care Patients ◽  
Subsyndromal Delirium ◽  
Hospitalization Time ◽  
Chi Square Test ◽  
The Relationship

ABSTRACT Objective: identify delirium and subsyndromal delirium in intensive care patients; age, hospitalization time, and mortality. Method: a retrospective, quantitative study conducted in the Intensive Care Unit, using the Richmond Agitation-Sedation Scale to evaluate sedation and the Intensive Care Delirium Screening Checklist for the identification of delirium, with the participation of 157 patients. For statistical analysis, the t-test and the Chi-square test was carried out. Results: the majority presented subsyndromal delirium (49.7%). Mortality was 21.7%. The relationship between delirium and its subsyndromal with hospitalization time was statistically significant for both (p=0.035 and p <0.001), while age was significant only in the subsyndromal delirium (p=0.009). Conclusion: the majority of the patients presented subsyndromal delirium. The length of hospital stay was statistically significant in delirium and subsyndroma delirium. Age was significant only in subsyndromal delirium. The mortality of patients with delirium was higher than the others.

scholarly journals Intravenous Lormetazepam during Sedation Weaning in a 26-Year-Old Critically Ill Woman

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Alawi Luetz ◽  
Bjoern Weiss ◽  
Claudia D. Spies
Keyword(s):  
Intracranial Hypertension ◽  
Critically Ill ◽  
Stress Reduction ◽  
Rare Case ◽  
Deep Sedation ◽  
Adverse Outcomes ◽  
Limited Period

Recent evidence revealed that sedation is related to adverse outcomes including a higher mortality. Despite this fact, patients sometimes require deep sedation for a limited period of time to control, for example, intracranial hypertension. In particular in these cases, weaning from sedation is often challenging due to emerging agitation, stress, and delirium. The submitted research letter reports a rare case of severe and persisting agitation that was unresponsive to all available treatments. Ultimately, lormetazepam which has recently become available for intravenous use in Germany resolved the problem by stress-reduction and anxiolysis without leading to measurable sedation.

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