• Am. J. Crit. Care · May 2022

    Observational Study

    Prospective Validation of Sedation Scale Scores That Identify Light Sedation: A Pilot Study.

    • Caitlin Brown, Pasquale Joseph Marotta, Richard R Riker, Ashley D Eldridge, Gilles L Fraser, and Teresa L May.
    • Caitlin Brown was a critical care pharmacy resident at Maine Medical Center, Portland, Maine, when the study was done and is currently a neurocritical care and emergency medicine pharmacist at Mayo Clinic, Rochester, Minnesota.
    • Am. J. Crit. Care. 2022 May 1; 31 (3): 202-208.

    BackgroundIntensive care unit (ICU) sedation guidelines recommend targeting a light sedation level, but light sedation has no accepted definition, and inconsistent levels have been proposed.ObjectiveTo determine Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores that best describe patients' ability to follow voice commands.MethodsThis prospective, observational pilot study enrolled a convenience sample of ICU patients receiving mechanical ventilation. Pairs of trained investigators evaluated scores on the Sedation-Agitation Scale and Richmond Agitation-Sedation Scale and ability to follow commands before and up to 2 hours after sedation lightening in a blind, independent, simultaneous fashion. Positive predictive values (PPVs) and likelihood ratios (LRs) of Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores associated with light sedation (ability to follow at least 3 commands) were calculated.ResultsNinety-six assessments (50 before and 46 after lightening of sedation) were performed in medical ICU patients. Scores best associated with ability to follow at least 3 commands were Sedation-Agitation Scale score of 4 (PPV, 0.88; 95% CI, 0.70-0.98; LR, 14.0) and Richmond Agitation-Sedation Scale score of -1 (PPV, 0.81; 95% CI, 0.61-0.93; LR, 10.7), superior to previously recommended thresholds of Sedation-Agitation Scale score of 3 (PPV, 0.62; 95% CI, 0.48-0.75; LR, 3.1) and Richmond Agitation-Sedation Scale score of -3 (PPV, 0.52; 95% CI, 0.39-0.64; LR, 2.0).ConclusionsThe level of sedation most associated with the ability to follow commands appears higher than previously recommended. Further study is needed regarding the effects of sedation level on ICU patients' ability to follow commands and assessment of delirium, pain, and patient preferences.©2022 American Association of Critical-Care Nurses.

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