Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery

Riker, Richard R.; Fraser, Gilles L.; Simmons, LaVone E.; Wilkins, Micheline L.

doi:10.1007/s001340100912

Cited by 211 publications

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“…This was not different from other validation studies, in which intubated patients accounted for between 35 and 100% of all patients. 8,9,11,17,18 Our study has some limitations. Firstly, the investigators were only trained for a short time before applying the sedation scales.…”

Section: Discussionmentioning

confidence: 91%

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Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

et al. 2008

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CONTEXT AND OBJECTIVE: Sedation scales are used to guide sedation protocols in intensive care units (ICUs). However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS). DESIGN AND SETTING: Validation study in two mixed ICUs of a university hospital. METHODS: All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident). We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k) and correlations used Spearman's test. RESULTS: 136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90). RASS (weighted k 0.82-0.87) and SAS (weighted k 0.83-0.90) had the best agreement. All scales had a good and significant correlation with each other. CONCLUSIONS: All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.

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Section: Discussionmentioning

confidence: 91%

“…Other validation studies have used a greater number of patients. 8,9,17,18 However, our study included 136 observations made by four different members of the multidisciplinary team. Only the RASS validation studies in English were conducted with four or more different individuals applying a scale.…”

Section: Discussionmentioning

confidence: 99%

Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

et al. 2008

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“…In such circumstances, it is best to spend longer than just the average 1 minute that it takes to do the CAM-ICU, and, instead to generate higher sensitivity, it should be considered necessary to invest upward of 10 minutes with the evaluation, as is often done with other instruments, such as the full CAM or DRS-R98 [44, 45]. The CAM-ICU is used in combination with an "arousal scale," such as the Riker Sedation-Agitation Scale (SAS) [46,47], or the Richmond AgitationSedation Score (RASS) [48,49] to create a "sisterinstrument" 2-step approach to the examination of consciousness, summarized as a CAM-ICU flowsheet or algorithm that has a number of advantages [12]:…”

Section: Definition Risk Factors and Monitoring For Deliriummentioning

confidence: 99%

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

2012

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Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system.

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“…БСИ является экспертным методом оценки гипнотического компонента общей анестезии и до настоящего времени не имеет широкого распространения в практике ОРИТ [41][42][43]. В полной мере это относится и к другим вари антам ЭЭГ мониторинга седации.…”

Section: о б з о р ыunclassified

The α2-Adrenoceptor Agonist Dexmedetomidine in Current Sedation Practice

Kozlov¹

2013

rmt

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О Б Щ А Я Р Е А Н И М А Т О Л О Г И Я , 2 0 1 3 , I X ; 2 55 О б з о р ы Проблема седации в отделениях реанимации и интен сивной терапии (ОРИТ), постоянно сохраняет научно практи ческую актуальность [1][2][3][4][5]. Система PubMed при запросе «sedation in ICU» приводит ссылки более чем на 900 публика ций за 1980-2012 гг., причем за последние 5 лет публикуется не менее 70 статей ежегодно. Многие из этих работ посвящены внедрению в практику новых препаратов для седации, особен ностям их фармакодинамических эффектов в различных кли нических ситуациях, преимуществам и недостаткам использо вания. В 2000 х годах начало возрастать число публикаций, посвященных применению для седации в ОРИТ специфичес кого агониста α 2 адренергических рецепторов (α 2 АР) дексме детомидина [5].Агонисты α α 2 АР в анестезиологии реаниматологии. Дексмедетомидин относится к классу α 2 адреномиметиков, которые привлекли внимание анестезиологов реаниматологов в конце 1970 х годов. Производное имидазолина агонист α 2 АР клонидин (клофелин) был введен в клиническую практику более 35 лет назад в качестве гипотензивного препарата. Вско ре начались исследования по его использованию при общей анестезии. В эксперименте было показано существенное сни жение минимальной альвеолярной концентрации (МАК) га лотана при его сочетанном назначении с клонидином [6][7][8][9]. Дексмедетомидин, синтезированный в 1986 г. финскими ис следователями, сразу стали изучать в качестве возможного компонента общей анестезии и седативного препарата. Экспе Проблема седации в отделениях реанимации и интенсивной терапии, имеет несомненную научно практическую актуальность. Многие современные исследования посвящены внедрению в практику новых препаратов для седа ции, особенностям их фармакодинамических эффектов в различных клинических ситуациях, преимуществам и недостаткам использования. В последние годы начало возрастать число публикаций, посвященных применению для седации специфического агониста α α 2 адренергических рецепторов дексмедетомидина. В статье представлен обзор современных публикаций по вопросам применения агонистов α α 2 адренорецепторов в анестезиологии реа ниматологии, рассмотрены физиология α α адренорецепторов и механизм седативного эффекта дексмедетомиди на, его фармакокинетика и фармакодинамика при различных концентрациях в плазме. Подробно освещен опыт применения дексмедетомидиновой седации в клинической практике по данным современных многоцентровых рандомизированных исследований, в которых препарат сравнивали с другими лекарственными средствами для седации (пропофол, мидазолам, лоразепам). Проанализированы отдельные аспекты клинической фармакологии дексмедетомидина: влияние препарата на головной мозг и мозновой кровоток, ноцицепцию, симпатоадренало вую систему, гемодинамику, систему дыхания, терморегуляцию, иммунитет и нейроэндокринную систему. Про анализирована клиническая значимость различных рецепторозависимых эффектов препарата и особенности его использования в различных ситуациях. Ключевые слова: дексмедетомидин, седация у реаниматологических больных, с...

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Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery

Abstract: Sedation-Agitation Scale and BIS are valid measures of wakefulness after cardiac surgery, but EMG interference may affect the accuracy of BIS for a small percentage of patients not receiving neuromuscular blockade.

Cited by 211 publications

References 0 publications

Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

The α2-Adrenoceptor Agonist Dexmedetomidine in Current Sedation Practice

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