The Effect of Sedation Protocol Using Richmond AgitationSedation Scale (RASS) on Some Clinical Outcomes of Mechanically Ventilated Patients in Intensive Care Units: a Randomized Clinical Trial

Abstract

Introduction:Providing for patients' comfort and reducing their pain is one of the important tasks of health care professionals in the Intensive Care Unit (ICU). The current study was conducted to determine the effect of a protocol using a Richmond Agitation-Sedation Scale (RASS) on some clinical outcomes of patients under mechanical ventilation (MV) in 2017. Methods:This single-blind clinical trial was conducted on 79 traumatic patients in the ICU who were randomly allocated into the intervention (N=40) and the control groups (N=39). The sedation was achieved, using a sedation protocol in the intervention group and the routine care in the control group. The clinical outcomes of the patients (duration of MV, length of staying in ICU, final outcome) were measured. As the participants had different lengths of MV and staying in ICU, the data were restructured, and were analyzed, using proper statistical methods. Results:The patients' level of sedation in the intervention group was significantly closer to the ideal score of RASS (-1 to +1). The duration of MV was significantly reduced in the intervention group, and the length of stay in the ICU was also significantly shorter. There was no difference in terms of final outcome. The ICU cost in the control group was twice as high as the cost in of the intervention group. Conclusion:The applied sedation protocol in this study would provide better sedation and could consequently lead to significantly better clinical outcomes, and the cost of caring as a result.Citation: Taran Z, Namadian M, Faghihzadeh S, Naghibi T. The effect of sedation protocol using Richmond agitation-sedation scale (RASS) on some clinical outcomes of mechanically ventilated patients in intensive care units.

An importance of respiratory drive and effort during mechanical ventilation

“…However, the goal for light sedation is approximately -1 to 0 in most mechanically ventilated patients. A study on RASS among mechanically ventilated patients who required sedative drugs revealed that this method could shorten ventilator duration by 5 days (P<0.001), as well as hospitalization duration by 9 days respectively (P<0.001), and reduced the cost of hospitalization significantly [52]. In addition, it is convenient and easy to process as it can be done at the besides without any additional equipment required.…”

Weaning success among COPD patients following ventilator care bundle application

“…[51] This finding is in harmony with the results of several studies which highlighted that nurses utilizing RASS limit the over-sedation of ventilated patients, thereby reducing the number of MV days in the ICU. [52][53][54] Furthermore, Klompas et al [55] reported that sedative infusion interruptions were associated with faster extubation time and lower rates of ventilator mortality.…”

Community hospital experience in the emergency management of COVID‐19: Preventing morbidity and preserving resources

“…Sedation and analgesia goals as measured by externally validated behavioral assessment tools, the Richmond Agitation-Sedation Scale (RASS), and the Critical-Care Pain Observation Tool (CPOT), are targeted first using an opioid analgesic. 23,25,26 If goals are not met, a sedative medication is added, typically either propofol or dexmedetomidine. This RASS-centered sedation strategy can be seen illustrated in Figure 3C.…”