| Guías para sedación, analgesia y bloqueo neuromuscular en la terapia intensiva |
Guidelines for sedation, analgesia and neuromuscular blockade in the Intensive Care Unit
Vanderbilt Medical Center
Introduction
Sedatives and analgesics are the most commonly administered medication in both surgical and medical ICU accounting for 10-15% of the total drug costs. Despite JCAHO mandates and available guidelines, inadequate or excessive sedation and analgesia still is common in intensive care units. Failure to meet goals of proper sedation and analgesia have deleterious sequele that are associated with an increase in adverse events, poor outcomes, longer ICU stays and economic effects. Recent studies have shown better outcomes and cost savings using protocol driven sedation and analgesia guidelines. Patients who were woken up on a regular basis during their ICU stays had lesser days on ventilators. Use of tools such as the Ramsay sedation scale as well as the Visual Analog Scale (VAS) and the FACES scale for pain have made titration of drugs more precise and cost effective In an attempt to improve sedation and analgesia in our ICU patients, thereby improving patient outcome and costs the following guidelines have been created. These guidelines are based on recommendations developed by the Society of Critical Care Medicine ( January 2002) combined with data on the pharmacodynamics and pharmacokinetics of the drugs in the critically ill We will use the Ramsay sedation scale or the Richmond Agitation Sedation Scale (RASS) and the VAS and FACES scale for pain assessment
http://www.traumaburn.com/Protocols/SedationAnalgesiaGuidelines.pdf
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| Como utilizar la escala de Ramsay para evaluar el nivel de sedación en UCI |
How to use the Ramsay Score to assess the level of ICU Sedation
Michael A. E. Ramsay M.D
Introduction
Virtually every patient admitted into the intensive care unit (ICU) is administered sedation therapy. The precise control of the depth of sedation is often not well managed. Patients are frequently over or under-sedated with, as a result of this lack of control, an accompanying increase in morbidity, mortality and economic cost. Over 25 years ago, an attempt was initiated to bring the control of sedation level up to the same level of intense management as the control of hemodynamics, fluid and electrolyte balances, oxygen and metabolic parameters. This concept has taken a long time to reach the critical care pathway of the majority of ICUs. However, economic issues and advances in pharmacology, have lead to a critical re-evaluation of sedation techniques, so that the goal of a heavily sedated or comatose patient for the maintenance of ventilator synchrony, is now changing to the goal, where possible, of a calm, co-operative, comfortable and communicative patient, who can interact with family members and medical staff. This change in practice pattern has resulted in shorter periods of time on mechanical ventilation support, leading to a shorter stay in the intensive care unit.
http://5jsnacc.umin.ac.jp/How%20to%20use%20the%20Ramsay%20Score%20to%20assess%20the%20level%20of%20ICU%20Sedation.htm |
| Escalas de sedación: muy útiles, poco utilizadas |
Sedation scales: Very useful, very underused
S. P. Stawicki, MD
Principal Scientist, OPUS 12 Foundation, King of Prussia, PA, USA
OPUS 12 Scientist 2007 Vol. 1, No. 2
Majority of critically ill patients experience significant distress, anxiety, and agitation during their intensive care unit (ICU) stays. Numerous factors, including sleep deprivation, unfamiliar environment, delirium, adverse medication effects, pain, and extreme anxiety can contribute to ICU patient distress.
http://www.opus12.org/uploads/O12-SCI-V01-N02-P10.pdf |
| Validez y fiabilidad de la escala Richmond de agitación-sedación en pacientes adultos en UCI |
The Richmond Agitation-Sedation Scale Validity and Reliability in Adult Intensive Care Unit Patients
Curtis N. Sessler, Mark S. Gosnell, Mary Jo Grap, Gretchen M. Brophy, Pam V. O'Neal, Kimberly A. Keane, Eljim P. Tesoro, and R. K. Elswick
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine; School of Nursing and Nursing.
Am J Respir Crit Care Med Vol 166. pp 1338-1344, 2002
Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter rater reliability and validity of a new 10-level (_4 "combative" to 5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r 0.956, lower 90% confidence limit 0.948; 0.73, 95% confi dence interval0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n _ 192). Robust inter-rater reliability (r 0.922-0.983) (0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing RASS correlated highly (r_0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r 0.84-0.98). In the second phase, after implementation of RASS our medical ICU, inter rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r 0.964, lower 90% confidence limit _ 0.950; _ _ 0.80, confidence interval _ 0.69, 0.90) and very good for all subgroups (r _ 0.773-0.970, _ _ 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r _ _0.78) and the Sedation Agitation Scale (r _ 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and non ventilated, and sedated and nonsedated adult ICU patients.
Keywords: sedation; agitation; mechanical ventilation; validation; scale
http://ajrccm.atsjournals.org/content/166/10/1338.full.pdf
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