Monitoring the depth of palliative sedation by video-pupillometry: A case report

2021 ◽  
pp. 026921632110427
Author(s):  
Elyn Antoine ◽  
Saffon Nicolas ◽  
Larson Merlin
Keyword(s):  
Pupil Size ◽  
Metastatic Cancer ◽  
Palliative Sedation ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Actual Case ◽  
Clinical Scales ◽  
Course Of Action ◽  
Research Problems ◽  
Pupillary Reactivity

Background: Palliative sedation is sometimes interrupted by undesired arousals. Pupillometry has been used in anesthesiology to monitor pain and sedation but has never been used during palliative sedation. Actual case: A 48 years-old patient, with multi-metastatic cancer, underwent palliative sedation to manage global suffering. On the second day, the patient experienced arousal which required medication adjustments to ensure pain relief and increased sedation. Possible course of action: Depth of sedation is monitored with clinical scales, such as the Richmond Agitation-Sedation Scale. But these scales do not measure brain stem activity and are poor at predicting arousal. Formulation of a plan: During palliative sedation, an infrared pupillometer was used to monitor pupil size and pupillary reactivity (Neurolight®, IDMed®, Marseille, France). Outcome: The pupillary light reflex was depressed during deep sedation. In our case, we observed a low-normal reflex along with dilated pupil before arousal. Lessons from the case: Our case suggests that reflex intensity and pupil size might predict arousals during palliative sedation. View on research problems, objectives, or questions generated by the case: Prospective studies are needed to confirm our findings. Pupillometry’s acceptability should also be questioned from patient’s, families’, and caregivers’ perspectives.

P767Survey of palliative sedation at the end-of-life in terminally ill heart failure patients - a five year experience in national cardiovascular center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Nakai ◽  
Y Hamatani ◽  
M Miyata ◽  
E Nakamura ◽  
Y Kawano ◽  
...  
Keyword(s):  
Blood Pressure ◽  
End Of Life ◽  
Terminally Ill ◽  
Vital Signs ◽  
Palliative Sedation ◽  
P Value ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Cardiovascular Center ◽  
Sedative Agents

Abstract Background Palliative sedation is a therapeutic option when symptom relief is difficult to achieve at the end-of-life. However, little is known regarding palliative sedation in terminally ill heart failure (HF) patients. Purpose To survey the practice of palliative sedation in terminally ill HF patients at a tertiary referral cardiovascular center, and to investigate the efficacy and safety of sedative agents in HF patients. Methods We retrospectively reviewed consecutive patients who were referred to palliative care team at our institution between September 2013 and August 2018. Patients who were hospitalized for HF and died during hospitalization despite optimal medical therapy were selected and defined as terminally ill HF. We investigated the practice of palliative sedation in terminally ill HF patients and analysed the vital signs and sedation scale before starting sedative agents and about 1 hour afterward. Results Among 95 terminally ill HF patients, 37 were prescribed palliative sedation at the end-of-life (Picture). Of 37 patients (mean age: 70 years, median B-type natriuretic peptide: 1018 pg/ml, median creatinine: 3.0 mg/dl, intravenous inotrope: 81%), 25 were prescribed dexmedetomidine, and 12 were prescribed midazolam as first agent for sedation. Patient's backgrounds were comparable between the two groups. Richmond Agitation-Sedation Scale was significantly reduced (P<0.01), whereas blood pressure and heart rate were not altered after treatments in both groups. In midazolam group, significant decreases were noted regarding respiratory rate (P=0.01) and oxygen saturation (P=0.02); however, these parameters were not changed in dexmedetomidine group (Table). Table 1. Vital signs and sedation scale Dexmedetomidine group (n=25) Midazolam group (n=12) Baseline After P value Baseline After P value Richmond Agitation-Sedation Scale 1 (0, 1) −1 (−2, 0) <0.01 1 (0, 1) −2 (−3, −1) <0.01 Vital signs   Systolic blood pressure (mmHg) 90±15 89±16 0.51 89±21 84±23 0.33   Diastolic blood pressure (mmHg) 52±13 54±11 0.34 60±14 56±23 0.48   Heart rate (beats per minute) 95±20 91±22 0.17 90±21 90±19 0.70   Respiratory rate (breaths per minute) 22±5 20±5 0.24 21±5 17±2 0.01   Oxygen saturation (%) 97±3 96±6 0.59 96±5 94±5 0.02 Picture. Study flowchart Conclusions Dexmedetomidine and midazolam were commonly used in real-word practice for HF patients at the end-of-life. Although impact on respiratory system differed by treatments, both agents could be prescribed effectively and safely in terminally ill HF patients.

Implementing the ABCDE Bundle, Critical-Care Pain Observation Tool, and Richmond Agitation-Sedation Scale to Reduce Ventilation Time

2020 ◽  
Vol 31 (1) ◽  
pp. 16-21
Author(s):  
Jennifer Bardwell ◽  
Sushama Brimmer ◽  
Wesley Davis
Keyword(s):  
Critical Care ◽  
Prolonged Mechanical Ventilation ◽  
The United States ◽  
Evidence Based ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Early Mobility ◽  
Ventilation Time ◽  
The Awakening ◽  
Abcde Bundle

Prolonged mechanical ventilation of patients in intensive care units across the United States consumes billions of health care dollars every year. Using the awakening and breathing coordination, delirium monitoring/management, and early mobility (ABCDE) bundle along with the Critical-Care Pain Observation Tool and the Richmond Agitation-Sedation Scale combines the best available evidence to optimize outcomes for critically ill patients. This study is the first to examine the effects of implementing the ABCDE bundle, the Critical-Care Pain Observation Tool, and the Richmond Agitation-Sedation Scale together in a coordinated effort across multiple disciplines. The aim of using this combination of evidence-based tools is to reduce ventilation time by reducing oversedation, decreasing the incidence of delirium, and improving pain management.

Ramsay Sedation Scale and Richmond Agitation Sedation Scale

2019 ◽  
Vol 38 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Akram M. Rasheed ◽  
Mohammad F. Amirah ◽  
Mohammad Abdallah ◽  
Parameaswari P.J. ◽  
Marwan Issa ◽  
...  
Keyword(s):  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Ramsay Sedation Scale

Übersetzungsverfahren eines klinischen Assessmentinstrumentes am Beispiel der Richmond Agitation-Sedation Scale (RASS)

Pflege ◽  
2009 ◽  
Vol 22 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Ursi Barandun Schäfer ◽  
Paola Massarotto ◽  
Angelika Lehmann ◽  
Christoph Wehrmüller ◽  
Rebecca Spirig ◽  
...  
Keyword(s):  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Deutschsprachige Version

Patientinnen und Patienten von Intensivstationen werden sediert, um die Belastungen durch Erkrankung und/oder Behandlung zu reduzieren. Zur Vermeidung inadäquater Sedationstiefe und ihrer negativen Folgen wird die regelmäßige Erfassung der Sedationstiefe als Teil der zielorientierten Sedationspraxis empfohlen. Die Schweizerische Gesellschaft für Intensivmedizin verlangt von den anerkannten Intensivstationen die regelmäßige Dokumentation des Sedationsscores als festen Bestandteil des Minimalen Datensatzes (MDSi). Eine der beiden vorgeschlagenen Skalen für die Einschätzung der Sedation ist die zehnstufige Richmond Agitation-Sedation Scale (RASS). Da bisher keine validierte deutschsprachige Version vorliegt, wurde die englische Skala mittels systematischen Vorgehens in sechs Schritten ins Deutsche übersetzt. Im vorliegenden Artikel wird die Übersetzung der RASS für die Anwendung in der Deutschschweiz als Beispiel eines multiprofessionellen Übersetzungsprozesses beschrieben. Der Übersetzung von Instrumenten für den klinischen Gebrauch sollte ebenso viel Sorgfalt zukommen wie bei der Entwicklung von Forschungsinstrumenten. Es werden folgende Empfehlungen abgeleitet: a) Berücksichtigung von Fachliteratur nicht lediglich zum Gegenstand der Übersetzung, sondern auch zum geeigneten Vorgehen beim Übersetzen, b) Einbezug professioneller Übersetzerinnen und Übersetzer als sprachliche Expertise sowie c) Rücksprachen mit den Autoren und Autorinnen der Originalfassung.

scholarly journals Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU)

2021 ◽  
Author(s):  
Björn Weiss ◽  
Nicolas Paul ◽  
Claudia D. Spies ◽  
Dennis Ullrich ◽  
Ingrid Ansorge ◽  
...  
Keyword(s):  
Neurocritical Care ◽  
Test Validity ◽  
Repeated Measurements ◽  
Receiver Operating Characteristics ◽  
Patient Specific ◽  
Operating Characteristics ◽  
Sedation Scale ◽  
Richmond Agitation Sedation Scale ◽  
Dsm Iv ◽  
Neurosurgical Intervention

Abstract Background Delirium screening instruments (DSIs) should be used to detect delirium, but they only show moderate sensitivity in patients with neurocritical illness. We explored whether, for these patients, DSI validity is impacted by patient-specific covariates. Methods Data were prospectively collected in a single-center quality improvement project. Patients were screened for delirium once daily using the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Reference was the daily assessment using criteria from the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR). In a two-step receiver operating characteristics regression analysis adjusting for repeated measurements, the impact of acute diagnosis of stroke or transient ischemic attack (TIA), neurosurgical intervention, Richmond Agitation Sedation Scale, and ventilation status on test validity was determined. Results Of 181 patients screened, 101 went into final analysis. Delirium incidence according to DSM-IV-TR was 29.7%. For the first complete assessment series (CAM-ICU, ICDSC, and DSM-IV-TR), sensitivity for the CAM-ICU and the ICDSC was 73.3% and 66.7%, and specificity was 91.8% and 94.1%, respectively. Consideration of daily repeated measurements increased sensitivity for the CAM-ICU and ICDSC to 75.7% and 73.4%, and specificity to 97.3% and 98.9%, respectively. Receiver operating characteristics regression revealed that lower Richmond Agitation Sedation Scale levels significantly impaired validity of the ICDSC (p = 0.029) and the CAM-ICU in its severity scale version (p = 0.004). Neither acute diagnosis of stroke or TIA nor neurosurgical intervention or mechanical ventilation significantly influenced DSI validity. Conclusions The CAM-ICU and ICDSC perform well in patients requiring neurocritical care, regardless of the presence of acute stroke, TIA, or neurosurgical interventions. Yet, even very light or moderate sedation can significantly impair DSI performance.

Performance of the modified Richmond Agitation Sedation Scale in identifying delirium  in older ED patients

2017 ◽  
Vol 35 (9) ◽  
pp. 1324-1326 ◽  
Author(s):  
Florian F. Grossmann ◽  
Wolfgang Hasemann ◽  
Reto W. Kressig ◽  
Roland Bingisser ◽  
Christian H. Nickel
Keyword(s):  
Sedation Scale ◽  
Richmond Agitation Sedation Scale
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