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Sedation in ICU: are we achieving goals?
Samir Haddad1, Yaseen Arabi, Abdulaziz Al-Dawood
1Intensive Care Department, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia. haddads55@yahoo.com
Middle East Journal of Anaesthesiology
|December 3, 2009
Summary
Achieved sedation levels were consistently lower than physician goals in ICU patients, despite using the Riker Sedation-Agitation Scale (SAS) and a protocol. This highlights the need for improved sedation titration methods.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Patient Monitoring
Background:
- Effective sedation management is crucial for mechanically ventilated patients in the Intensive Care Unit (ICU).
- The Riker Sedation-Agitation Scale (SAS) is a validated tool for assessing sedation levels.
- Standardized protocols aim to optimize sedation titration and patient outcomes.
Purpose of the Study:
- To evaluate the achievement of sedation goals using the Riker Sedation-Agitation Scale (SAS) and a standardized protocol in ICU patients.
- To determine if a goal-directed sedation protocol improves the attainment of targeted sedation levels.
Main Methods:
- A nested prospective cohort study was conducted in a tertiary care medical-surgical ICU.
- Mechanically ventilated adult patients requiring >24 hours of intravenous sedation were included.
- A goal-directed protocol using the SAS was implemented after staff education, with SAS scores documented every 4 hours for the first five ICU days.
Main Results:
- 105 patients (mean age 47 years, APACHE II score 21) were analyzed.
- Achieved SAS scores were consistently lower than targeted goals during both day and night shifts.
- This discrepancy persisted throughout the study period, even after three months of protocol implementation.
Conclusions:
- Physician-ordered sedation goals were not consistently met in ICU patients, despite the use of the SAS and a standardized protocol.
- The persistent gap between targeted and achieved sedation levels suggests limitations in current titration strategies.
- Alternative, more precise methods for titrating sedation are needed to achieve desired patient sedation levels.
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