Goals of goal-directed sedation

Shehabi, Yahya

doi:10.5935/0103-507x.20150001

Cited by 2 publications

(2 citation statements)

References 10 publications

(11 reference statements)

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“…The SPICE III, ROSE and other trials, demonstrated a common trend towards deeper level of sedation in the first 48 hours of critical illness management [42,43,45,48,80]. While this may be a clinically desirable goal, light sedation to an awake, communicating and comfortable patient should be an immediate priority once the storm of initial instability has passed [79]. In particular, this ensures that a vital aspect of humane patient care -the provision of appropriate and adequate analgesia -is addressed early in the intensive care management journey.…”

Section: Personalised Patient-orientated Sedationmentioning

confidence: 99%

“…For fifteen years, the Sedation Practice in Intensive Care Evaluation (SPICE) program has explored the management of some or all aspects of sedation practice with the aim of providing clinically optimised sedation to all patients, irrespective of demographic or diagnosis [18,78,79]. SPICE III is the largest RCT of sedation practice by an order of magnitude [80], and has provided a wealth of information regarding the management of sedation in the critically ill. SPICE III enrolled 4000 patients over the age of 18 without significant neurological insult requiring sedation who were intubated and expected to require ongoing mechanical ventilation for at least a further 24 hours were randomised to open-label dexmedetomidine or usual care within 12 hours of initiation of invasive ventilation.…”

Section: Insights From the Spice III Trialmentioning

confidence: 99%

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Sedation management in the post-COVID era: A personalised, patient-orientated approach

John Glassford,

Shehabi

2024

Clin Crit Care

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Intensive care patients are older, frailer, and more co-morbid than ever before, and remain at risk of a variety of adverse outcomes, both in ICU, and after discharge. Sedation and delirium play an intricate role in this complex system, and it can be difficult to determine if they are a contributor or consequence in any given situation. During the COVID-19 pandemic, the increased frequency of complex ventilatory management, including prone ventilation and neuromuscular blockade, necessitated deep sedation in many cases. In concert with infection control concerns and staffing pressures, the delivery of precision symptom- and patient-oriented sedation has waned in favour of strategies felt to be globally safe. Using the SPICE III study as a lens to understand both the importance of exploring heterogeneity of effect in large, complex RCTs of critically ill patients, and the importance of an individualised approach to sedation in the intensive care unit, we demonstrate the evolution of our understanding of sedation in this challenging environment. By following the principles that define the cornerstones of best contemporary sedation practice we can once more grow beyond the boundaries of clinical practice guidelines in the provision of personalised, patient-orientated sedation in the post-COVID intensive care unit.

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Section: Personalised Patient-orientated Sedationmentioning

confidence: 99%

Section: Insights From the Spice III Trialmentioning

confidence: 99%

Sedation management in the post-COVID era: A personalised, patient-orientated approach

John Glassford,

Shehabi

2024

Clin Crit Care

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

Pop

Dervay

Dansby³

et al. 2018

Advanced Emergency Nursing Journal

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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.

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Goals of goal-directed sedation

Cited by 2 publications

References 10 publications

Sedation management in the post-COVID era: A personalised, patient-orientated approach

Sedation management in the post-COVID era: A personalised, patient-orientated approach

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

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