[EVALUATION OF SEDATION USING THE RICHMOND AGITATION SEDATION SCALE IN PATIENTS WITH PROLONGED MECHANICAL VENTILATION]. / Evaluación de la sedación mediante la escala Richmond Agitation Sedation Scale. EN PACIENTES CON VENTILACIÓN MECÁNICA DE LARGA DURACIÓN.

INTRODUCTION: Sedation is monitored to avoid both under- and oversedation. OBJECTIVES: Determine the most prevalent sedation levels in the ICU according to RASS categories and whether treatment is individualized on the basis of these scores. METHODS: Prospective cohort study of patients connected to mechanical ventilation ≥ 96 hours in the intensive care unit between January 1 and August 31. Daily assessments were recorded in the intensive care unit, together with sedoanalgesic treatment, ventilation modes, or vital signs. RESULTS: We analyzed 1021 RASS scores collected over a total of 220 MV days, categorized in the following ranges: 404 (39.6%) deep sedation, 474 (46.4%) conscious sedation, and 54 (5.3%) agitation; 89 (8.7%) were missing scores. Patients receiving continuous sedoanalgesia were more likely to be in the deep sedation than conscious sedation range (87.1% vs. 32.3%, p < 0.001). Analysis of patients under continuous sedation and in ventilation mode found more changes in the conscious sedation range than in deep sedation (42.5% vs. 22.3% and 12.6% vs. 2.9%, respectively; p < 0.001 in both cases). In conscious sedation range there was increased use of opiates in bolus (6.4%). CONCLUSIONS: Deep sedation was clearly prevalent in patients with mechanical ventilation under continuous sedation, with few changes in ventilation mode, because it is prevalent control ventilation mode and no changes in sedonalagesic perfusion in that range.

Evaluación de la sedación mediante la escala Richmond Agitation Sedation Scale en pacientes con ventilación mecánica de larga duración / Evaluation of sedation using the Richmond Agitation Sedation Scale in patients with prolonged mechanical ventilation

Introducción. Monitorizar la sedación es necesario para evitar la infra o sobresedación. Objetivos. Evaluar los niveles de sedación más prevalentes en la UCI de acuerdo a las categorías de la escala RASS y valorar si el tratamiento es individualizado. Métodos. Estudio prospectivo de cohortes en pacientes conectados a ventilación mecánica ≥ 96 horas por un periodo de 7 meses. Registro de los valores RASS, junto con el tratamiento sedoanalgésico, modos de ventilación mecánica y signos vitales. Resultados. Se analizaron 1021 valores RASS de 220 días de ventilación mecánica, categorizados en los siguientes rangos: 404 (39.6 %) sedación profunda, 474 (46.4 %) sedación consciente y 54 (5.3 %) agitación. Hubo 89 (8.7 %) valores faltantes. Los pacientes que recibieron sedoanalgesia continua estuvieron más tiempo en sedación profunda que consciente (87.1 % frente a 32.3 %, p < 0.001) y se realizaron más cambios de tratamiento en la sedación consciente que en la profunda, tanto en cuanto a sedoanalgesia en perfusión (42.5 % frente a 22.3 %, p < 0.001) como según modo ventilatorio (12.6 % frente a 2.9 %, p < 0.001). Para valores RASS en el rango de la sedación consciente había un incremento del uso de opiáceos en bolo (6.4 %). Conclusiones. La sedación profunda es predominante en pacientes con sedoanalgesia, con pocos cambios en el modo ventilatorio, ya que prevalece la modalidad controlada y no hay cambios en la perfusión de sedoanalgesia (AU)

Introduction. Sedation is monitored to avoid both under- and oversedation. Objectives. Determine the most prevalent sedation levels in the ICU according to RASS categories and whether treatment is individualized on the basis of these scores. Methods. Prospective cohort study of patients connected to mechanical ventilation ≥ 96 hours in the intensive care unit between January 1 and August 31. Daily assessments were recorded in the intensive care unit, together with sedoanalgesic treatment, ventilation modes, or vital signs. Results. We analyzed 1021 RASS scores collected over a total of 220 MV days, categorized in the following ranges: 404 (39.6 %) deep sedation, 474 (46.4 %) conscious sedation, and 54 (5.3 %) agitation; 89 (8.7 %) were missing scores. Patients receiving continuous sedoanalgesia were more likely to be in the deep sedation than conscious sedation range (87.1 % vs. 32.3 %, p < 0.001). Analysis of patients under continuous sedation and in ventilation mode found more changes in the conscious sedation range than in deep sedation (42.5 % vs. 22.3 % and 12.6 % vs. 2.9 %, respectively; p < 0.001 in both cases). In conscious sedation range there was increased use of opiates in bolus (6.4 %). Conclusions. Deep sedation was clearly prevalent in patients with mechanical ventilation under continuous sedation, with few changes in ventilation mode, because it is prevalent control ventilation mode and no changes in sedonalagesic perfusion in that range (AU)