Introduction: Proper sedation is an important factor for minimizing mortality and length-of-stay in the ICU. Previous studies have shown a correlation between heavier sedation and increased risk for mortality. Our overall study goal is to validate wrist accelerometers in optimizing sedation rates in the ICU. In this substudy, we investigated the patterns between target Richmond Agitation Sedation Scale (RASS) score and observed RASS score.
Methods: IRB approval was obtained for this study. Patients requiring mechanical ventilation in the neuroICU at the University of Minnesota were screened and enrolled. RASS scores were collected from nursing assessments. Mean RASS scores with standard deviations were calculated across patients. Probability for the RASS score to transition change at the subsequent time point was calculated and examined. The K-S test was used to compare transitional probabilities.
Results: 10 patients in the neuroICU were enrolled who were status-post neurosurgical interventions. Target RASS score was -1 for all patients based on standard of care for their diagnoses. The mean deviation from target RASS score across all patients was -1.8465 points. Each RASS score had the highest probability of staying the same from one time point to the next with an overall trend towards transitioning to a lower score (Table 1).
Conclusions: At our center, patients were consistently rated at a lower RASS score than their target and were more likely to have their score decrease over time. Probabilities for transition should indicate that patients should trend towards the goal RASS. Several possibilities exist for why this may not be true including difficult to control sedation and poor communication about goals. There is a significant opportunity for an automated system to measure the level of sedation to optimize patient outcomes, such as through wrist accelerometers.
Patient Care: Optimizing sedation levels is extremely important for minimizing ICU stay and mortality rates. Our research is investigating better ways to achieve this goal.
Learning Objectives: By the end of this session, participants should be able to:
1. Describe the role of RASS scores in managing sedation levels in the ICU.
2. Understand some of the issues arising from using RASS scores.
3. Discuss possibilities for improving sedation management in the ICU.
References: Shehabi, Y., Chan, L., Kadiman, S. et al. Intensive Care Med (2013) 39: 910. doi:10.1007/s00134-013-2830-2
Darrow D, Peterson N, Ladd B, Quinn C, Grande A. Prediction of Sedation Score Using Wireless Accelerometers. Journal of Neurotrauma. June 2016, 33(13): A-1-A-139.