Conscious sedation in the critically ill ventilated patient.
OBJECTIVE
The aim of sedation is to provide comfort and minimize anxiety. However, adverse effects are noteworthy, and the optimal end point of sedation in intensive care unit patients is still debated. We analyzed if a level 2 on the Ramsay Scale (ie, awake, cooperative, oriented, tranquil patient) is suitable for an invasive therapeutic approach.


METHODS
Forty-two patients requiring respiratory support and sedation for at least 4 days were enrolled in a prospective interventional cohort study aiming at maintaining patients awake and collaborative. The Ramsay score was recorded 3 times a day. Once a day, the nurse in charge evaluated adequacy of sedation according to the compliance with nursing care and therapeutic maneuvers in the previous 24 hours. Data were collected until patients were ventilated.


RESULTS
Overall, 264 of 582 days were classified as conscious. Sedation was adequate in 93.9% of them. In conscious days, a higher Simplified Acute Physiology Score II score and male sex significantly correlated with inadequate sedation.


CONCLUSIONS
In a population of severe intensive care unit patients, conscious sedation was achieved in almost half of the days spent on ventilation. The positive implications (eg, on length of weaning and cost of sedation) of a conservative sedation strategy may be highly relevant.
Cigada
Marco
M
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, Azienda Ospedaliera San Paolo di Milano, 20142 Milano, Italy.
Corbella
Davide
D
Mistraletti
Giovanni
G
Forster
Chiara Reali
CR
Tommasino
Concezione
C
Morabito
Alberto
A
Iapichino
Gaetano
G
D000367:Age Factors; D015897:Comorbidity; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D007362:Intensive Care Units; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors
D006634:Histamine H1 Antagonists; D006919:Hydroxyzine