[Sedation and analgesia assessment tools in ICU patients].
Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.
Thuong
M
M
Service de réanimation médicale, centre hospitalier de Saint-Denis, 2, rue du Docteur-Delafontaine, 93205 Saint-Denis, France. marie.thuong@ch-stdenis.fr
D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D054810:Deep Sedation / Q000379:methods*; D016903:Drug Monitoring / Q000379:methods; D004569:Electroencephalography / Q000187:drug effects; D004576:Electromyography; D005072:Evoked Potentials, Auditory / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000379:methods*; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D010147:Pain Measurement; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000517:prevention & control; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D054928:Validation Studies as Topic
D000700:Analgesics; D006993:Hypnotics and Sedatives