Monitoring Sedation Depth in Intensive Care Units

Tuesday, 14 July 2009: 2:05 PM

Li-Yin Chang, RN
1.School of Nursing 2.Department of Nursing, 1.National Yang Ming University, 2.Taichung Veterans General Hospital, Taichung, Taiwan
Yann-Fen Chao, PhD
School of Nursing, Taipei medical University, Taipei, Taiwan

Learning Objective 1: To understand the effectiveness of the subjective and objective tools for sedation monitoring in ICU.

Learning Objective 2: To understand the depth of sedation is correlated with risk of cardiovascular complications

Purpose: Sedation depth monitoring in intensive care unit (ICU) is important to avoid the problems of both under and over sedation but there is no gold standard. The purpose of study is to evaluate the effectiveness of the subjective and objective tools for sedation monitoring in ICU.

Methods:  23 medical ICU patients enrolled for this prospective cohort study. Patients who were on midazolam with/without neuromuscular blockade agents, was monitored 48 hours with Ramsay scale, the Richmond Agitation-Sedative Scale (RASS) and Bispectral Index (BIS) along with their heart rate (HR), respiratory rate (RR) and mean blood pressure (BP). Results:  A total of 1034 set data were obtained. The result reveals that the relevance of the measured values was: Ramsay scale and RASS (r =-0.85, p< .001), Ramsay scale and BIS (r =-0.41, p< 001), RASS and BIS (r =0.36, p<.001). The doses of sedative were also correlated significantly with heart rate (r =0.29, p< .001), respiratory rate (r =0.13, P< 001), the mean arterial pressure (r =-0.13, P< .001), and the oxygen saturation level (r =-0.27, p< .001). The proportion of deeply sedative level that can be accounted by each measures wereFRamsay scale 66.1%,RASS 68%,BIS (value<60) 59.1%.

Conclusion: In the majority with the severe sedative level, the sedative dosage with subjective tools are medium correlation, but not high correlate with BIS. Our finding suggests that the depth of sedation was correlated with risk of cardiovascular complications. The critical patients must have an effective assessment protocol for monitoring appropriate sedation depth to guarantee their safety.