Evaluation of Richmond Agitation Sedation Scale (RASS) in Mechanically Ventilated in the Emergency Department

Abstract

The purpose of this study was to assess Richmond Agitation Sedation Scale (RASS) goal implementation in mechanically ventilated patients sedated in the emergency department (ED), compliance with RASS, and goal achievement. This study was a retrospective chart review at a large Level I trauma academic medical center. Patients who were intubated in the ED or en route to the ED between October 1, 2013, and October 1, 2014, were eligible for inclusion if they met the following criteria: aged 18 years or older, 24 hr or more on mechanically ventilated support receiving continuous sedation and/or analgesia during the first 48 hr of admission, and a hospital stay of 6 days or more. There were 205 patients identified; 104 failed inclusion, 101 were enrolled, and 62 were excluded. Thirty-nine patients (94.9%) had an RASS goal implemented in the ED, of which 37 patients (81.1%) had an RASS goal set by an ED physician. Assessment of the RASS was found to be inconsistent, as 56.8% of patients were evaluated by an ED nurse within 1 hr of sedative initiation. Of the 37 patients who had an RASS goal in the ED, 18.9% achieved their goal in the ED. A review of sedation prescribing revealed that 39% received a regimen of varied combinations of continuous infusions of propofol, dexmedetomidine, and midazolam throughout admission, 33% received a regimen of 2 of the aforementioned drugs, and 28% received only propofol. Median extubation time was 129 hr. Seven patients expired within 180 days of admission. The assessment of the RASS was a common practice, but there were inconsistencies in measurement. A limited number of patients achieved their RASS goal in the ED. These results support a provider and nursing knowledge deficit regarding RASS goal setting, proper documentation of RASS measurement, and the need for appropriate assessments.

Outcomes of ventilatory asynchrony in patients with inspiratory effort

“…Variables related to sedation were the use and dose of sedative and the Richmond Agitation-Sedation Scale score (RASS; agitated ≥ 1 point; awake and calm/light sedation 0 to -2 points; and deep sedation ≤ -3 points). ( 10 )…”

Intrahospital treatment options of patients with polytrauma: Trauma protocol

“…Prilikom kontinuirane primene sedativnih agenasa, kao i tokom primene ostale terapije kod traumatizovanog pacijenta, naročito je potrebno voditi računa o kontekst-senzitivnom poluvremenu eliminacije, zbog produženog metabolizma i usporene eliminacije, a s obzirom na hemodinamske posledice traumatskog procesa. Tokom primene procedure sedacije, trebalo bi da se koriste skale za procenu stepena sedacije, od kojih je visoko preporučena Ričmondova skala agitacije i sedacije, ili da se primenjuju neinvazivni postupci neuromonitoringa, kao što je bispektralna metoda 42,43 .…”

A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service

“…Consequences of inappropriate analgesia and sedation practices are numerous, particularly in the post-intubation period. Deeper sedation, whether long term or in the early post-intubation period in the emergency setting has been associated with increased mortality, hospital length-of-stay (LOS), longer ventilation days and delirium [ 4 , 5 ]. Conversely, inadequate sedation and analgesia (especially when pharmacologically paralysed) may lead to increased catecholamine release with a resultant multitude of undesirable consequences, including self-extubation with resultant aspiration, hypoxia, or death [6] , [7] , [8] .…”