Prospective Validation of Sedation Scale Scores That Identify Light Sedation: A Pilot Study

Authors

Caitlin Brown, Caitlin Brown was a critical care pharmacy resident at Maine Medical Center, Portland, Maine, when the study was done and is currently a neurocritical care and emergency medicine pharmacist at Mayo Clinic, Rochester, Minnesota.
Pasquale Joseph Marotta, Pasquale Joseph Marotta was a medical student at University of New England College of Osteopathic Medicine during the study and is now a senior internal medicine resident at Maine Medical Center.
Richard R. Riker, Richard R. Riker is director of medical critical care, Department of Critical Care Services, Maine Medical Center.
Ashley D. Eldridge, Ashley D. Eldridge is a clinical research coordinator and a bedside nurse in the Special Care Unit at Maine Medical Center.
Gilles L. Fraser, Gilles L. Fraser was the critical care pharmacist at Maine Medical Center at the time of the study, and is now manager of Smiling Gil Farm.
Teresa L. May, Teresa L. May is a neurointensivist and medical intensivist, Department of Critical Care Services, Maine Medical Center.

Document Type

Article

Publication Date

5-1-2022

Institution/Department

Critical Care Medicine

Journal Title

American journal of critical care : an official publication, American Association of Critical-Care Nurses

MeSH Headings

Conscious Sedation; Critical Care; Humans; Hypnotics and Sedatives; Intensive Care Units; Pilot Projects; Prospective Studies; Psychomotor Agitation; Respiration, Artificial

Abstract

BACKGROUND: Intensive care unit (ICU) sedation guidelines recommend targeting a light sedation level, but light sedation has no accepted definition, and inconsistent levels have been proposed. OBJECTIVE: To determine Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores that best describe patients' ability to follow voice commands. METHODS: This prospective, observational pilot study enrolled a convenience sample of ICU patients receiving mechanical ventilation. Pairs of trained investigators evaluated scores on the Sedation-Agitation Scale and Richmond Agitation-Sedation Scale and ability to follow commands before and up to 2 hours after sedation lightening in a blind, independent, simultaneous fashion. Positive predictive values (PPVs) and likelihood ratios (LRs) of Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores associated with light sedation (ability to follow at least 3 commands) were calculated. RESULTS: Ninety-six assessments (50 before and 46 after lightening of sedation) were performed in medical ICU patients. Scores best associated with ability to follow at least 3 commands were Sedation-Agitation Scale score of 4 (PPV, 0.88; 95% CI, 0.70-0.98; LR, 14.0) and Richmond Agitation-Sedation Scale score of -1 (PPV, 0.81; 95% CI, 0.61-0.93; LR, 10.7), superior to previously recommended thresholds of Sedation-Agitation Scale score of 3 (PPV, 0.62; 95% CI, 0.48-0.75; LR, 3.1) and Richmond Agitation-Sedation Scale score of -3 (PPV, 0.52; 95% CI, 0.39-0.64; LR, 2.0). CONCLUSIONS: The level of sedation most associated with the ability to follow commands appears higher than previously recommended. Further study is needed regarding the effects of sedation level on ICU patients' ability to follow commands and assessment of delirium, pain, and patient preferences.

Comments

Pasquale Marotta- Resident

First Page

202

Last Page

208

Recommended Citation

Brown C, Marotta PJ, Riker RR, Eldridge AD, Fraser GL, May TL. Prospective Validation of Sedation Scale Scores That Identify Light Sedation: A Pilot Study. Am J Crit Care. 2022 May 1;31(3):202-208. doi: 10.4037/ajcc2022437. PMID: 35466351.