Related Experiment Videos
Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung
W Brunow de Carvalho1, P S Lucas da Silva, C S Paulo
1Pediatric Intensive Care Unit, Hospital do Servidor Público Municipal de São Paulo, Brazil.
Insights
The Comfort and Hartwig sedation scales showed no statistically significant difference in assessing sedation in pediatric patients on mechanical ventilation. Both scales effectively evaluated pediatric sedation levels, with similar outcomes for adequate, insufficient, and over-sedation.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Nursing
Background:
- Inadequate sedation and analgesia evaluation is common in hospitalized children.
- Accurate assessment of pediatric pain and anxiety is crucial for effective treatment.
- Advancements in sedation knowledge necessitate improved assessment tools.
Purpose of the Study:
- To compare the efficacy of the Comfort and Hartwig sedation scales.
- To evaluate sedation assessment in pediatric patients requiring mechanical lung ventilation.
Main Methods:
- Prospective cohort study conducted in a pediatric intensive care unit.
- Thirty simultaneous observations by specialists on 18 pediatric patients.
- Application of Comfort and Hartwig scales after 3 minutes of observation.
- Agreement rate (kappa) was the primary measurement.
Main Results:
- Comfort scale averages: adequate (20.28), insufficient (27.5), over-sedated (15.1).
- Hartwig scale averages: adequate (16.35), insufficient (20.85), over-sedated (13.0).
- Observed agreement rate was 63% (Kappa = 0.345).
Conclusions:
- No statistically significant difference found between Comfort and Hartwig scales for pediatric sedation assessment.
- Both scales demonstrated comparable effectiveness in evaluating sedation levels.
- The complexity of the scale (Comfort: 8 parameters; Hartwig: 5 parameters) did not yield significantly different outcomes.
Context:
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.
Design:
Prospective cohort study.
Setting:
A pediatric intensive care unit with three beds at an urban teaching hospital.
Patients:
Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied.
Diagnostic Test:
Comfort and Hartwig scales were applied, after 3 minutes of observation.
Main Measurements:
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.