Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation.
BACKGROUND
A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made.


OBJECTIVE
A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation.


METHODS
Prospective cohort study.


METHODS
A pediatric intensive care unit with three beds at an urban teaching hospital.


METHODS
Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied.


METHODS
Comfort and Hartwig scales were applied, after 3 minutes of observation.


METHODS
Agreement rate (kappa).


RESULTS
On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63% (p = 0.006) and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49).


CONCLUSIONS
In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.
Brunow de Carvalho
W
W
Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal de São Paulo, Brazil.
Lucas da Silva
P S
PS
Paulo
C S
CS
Fonseca
M M
MM
Belli
L A
LA
D002675:Child, Preschool; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010147:Pain Measurement; D011446:Prospective Studies; D012121:Respiration, Artificial