Assessment of sedation in the TICU
Why sedate in the ICU?
- Patients in the TICU are in pain and uncomfortable
- Sedatitives reduce anxiety, decrease awareness of unpleasant stimuli, induce sleep.
- They do not address pain, although some pain medications can assist or influence sedation level.
- Amnesia
- good for procdures
- patients on paralytics
- Safety and agitation
- Ventilator tolerance
- sleep deprivation
- Anxiety/Fear
- Delirium
Assessing sedation level
- The Richmond Agitation-Sedation Scale (RASS) is a reliable way to quantify level of sedation in the ICU patient (Ely_Etal_2003).
| Score | Term | Description |
|---|---|---|
| -5 | Unarousable | No response to verbal of physical stimuli |
| -4 | Deep sedation | No response to voice but response to physical stimuli |
| -3 | Moderate sedation | Movement or eye opening to voice but no eye contact |
| -2 | Light sedation | Awakens for <10 seconds and brief eye contact |
| -1 | Drowsy | Sustained awakening >10 seconds |
| 0 | Alert and calm | |
| 1 | Restless | Anxious |
| 2 | Agitated | Fights vent |
| 3 | Very agitated | Pulls at tubes, aggressive |
| 4 | Combatitive | violent |
- Goal RAAS is -1 to 0.
References
- Sedation drips in the ICU youtube video
- Ely EW, Truman B, Shintani A, et al. Monitoring Sedation Status Over Time in ICU Patients: Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983. doi:10.1001/jama.289.22.2983