Escalas de Ramsay e Richmond são equivalentes para a avaliação do nível de sedação em pacientes gravemente enfermos

Abstract

4 ou Richmond < -3) correlacionou-se positivamente com uma maior probabilidade de morte, com uma área sob a curva (ASC) > 0,78. Níveis adequados de sedação (Ramsay 2 a 4 ou Richmond 0 a -3) correlacionaram-se sensivelmente à probabilidade de sobrevivência, com uma ASC > 0,80. Em 63 evoluções (8,64%) foram observados níveis baixos de sedação, porém não se evidenciou nenhuma correlação entre a ocorrência de agitação e prognósticos desfavoráveis. Houve uma boa correlação entre as escalas Ramsay e Richmond (Pearson > 0,810 - p<0,0001). CONCLUSÃO: Neste estudo, as escalas de Ramsay e Richmond mostraram-se equivalentes para a avaliação de sedações profunda, insuficiente e adequada e ambos demonstraram boa correlação com mortalidade em pacientes excessivamente sedados.]]>

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

“…A major objective of health professionals assisting children admitted to the PICU is to carry out treatments implying the less possible aggression to prevent further physical and emotional distress for children and their relatives 1,2 . This scenario of severe psychic impact added to the need for mechanical ventilation support, is among the most common indications for the use of analgesia and/or sedation for these patients.…”

“…This scenario of severe psychic impact added to the need for mechanical ventilation support, is among the most common indications for the use of analgesia and/or sedation for these patients. 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] .…”

“…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.…”