Sedation assessment in critically ill adults

OBJECTIVE: To review methods for assessing sedation in critically ill adults, discuss their impact on patient outcomes, and provide recommendations for implementing these methods into clinical practice in the intensive care unit (ICU). DATA SOURCES: A computerized search of MEDLINE from 1980 through June 2000 and a manual search of abstracts presented at recent critical care meetings were performed. STUDY SELECTION AND DATA EXTRACTION: Sedation assessment tools that have been used to titrate therapy in adult, critically ill patients were identified. Special emphasis was placed on sedation assessment instruments that have been prospectively validated. Objective methods that have been used to assess sedation therapy were also identified. DATA SYNTHESIS: Twenty-three adult sedation assessment instruments were identified. Few scales have been prospectively evaluated for validity (n = 6) or reliability (n = 7). Other methods of sedation assessment were identified (e.g., bispectral index monitor); however, most of these methods have only been studied in small subsets of critically ill patients. CONCLUSIONS: Incorporation of sedation assessment into ICU clinical practice may improve patient care. These sedation assessment instruments must be further evaluated to determine their impact on quality of care and ICU length of stay.

This article has been cited by other articles:

				J. W. Devlin, J. J. Fong, E. P. Howard, Y. Skrobik, N. McCoy, C. Yasuda, and J. Marshall Assessment of Delirium in the Intensive Care Unit: Nursing Practices And Perceptions Am. J. Crit. Care., November 1, 2008; 17(6): 555 - 565. [Abstract] [Full Text] [PDF]

				P. M. Szumita, S. A. Baroletti, K. E. Anger, and M. E. Wechsler Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine Am. J. Health Syst. Pharm., January 1, 2007; 64(1): 37 - 44. [Abstract] [Full Text] [PDF]

				B. D Watson and S. L Kane-Gill Sedation Assessment in Critically Ill Adults: 2001-2004 Update Ann. Pharmacother., November 1, 2004; 38(11): 1898 - 1906. [Abstract] [Full Text] [PDF]

				D. Li and K. Puntillo What is the current evidence on pain and sedation assessment in nonresponsive patients in the intensive care unit? Crit. Care Nurse, October 1, 2004; 24(5): 68 - 3. [Full Text] [PDF]

				D. M. Olson, S. M. Chioffi, G. E. Macy, L. G. Meek, and H. A. Cook Potential Benefits of Bispectral Index Monitoring in Critical Care: A Case Study Crit. Care Nurse, August 1, 2003; 23(4): 45 - 52. [Full Text] [PDF]

				M. Saito, Y. Terao, M. Fukusaki, T. Makita, O. Shibata, and K. Sumikawa Sequential Use of Midazolam and Propofol for Long-Term Sedation in Postoperative Mechanically Ventilated Patients Anesth. Analg., March 1, 2003; 96(3): 834 - 838. [Abstract] [Full Text] [PDF]