Evaluating and monitoring analgesia and sedation in the intensive care unit

Critical Care

Volumn 12, Issue SUPPL. 3, 2008, Pages

  Sessler, Curtis N ^a   Jo Grap, Mary ^b   Ramsay, Michael A E ^c  

^a VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b VIRGINIA COMMONWEALTH UNIVERSITY   (United States)

^c BAYLOR UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGITATION; ANALGESIA; BEHAVIOR PAIN SCALE; BRAIN FUNCTION; CLINICAL ASSESSMENT TOOL; CLINICAL EFFECTIVENESS; CLINICAL EVALUATION; COGNITION; COMFORT SCALE; COMPREHENSION; CONSCIOUSNESS LEVEL; CRITICAL CARE PAIN OBESERVATION TOOL; CRITICALLY ILL PATIENT; ELECTROENCEPHALOGRAPHY; FACE LEGS ACTIVITY CRY CONSOLABILITY OBSERVATIONAL TOOL SCALE; HUMAN; INTENSIVE CARE; INTENSIVE CARE UNIT; MINNESOTA SEDATION ASSESSMENT TOOL; MONITOR; MOTOR ACTIVITY ASSESSMENT SCALE; NUMERIC PAIN SCALE; PAIN; PAIN ASSESSMENT; PATIENT MONITORING; PATIENT SAFETY; PRIORITY JOURNAL; RAMSEY SEDATION SCALE; RELIABILITY; REVIEW; RICHMOND AGITATION SEDATION SCALE; SEDATION; SEDATION AGITATION SCALE; SELF REPORT; VALIDITY; VANCOUVER INTERACTIVE AND CALMNESS SCALE; CONSCIOUS SEDATION; MONITORING; STANDARD;

ANALGESIC AGENT; HYPNOTIC SEDATIVE AGENT;

ANALGESIA; ANALGESICS; CONSCIOUS SEDATION; ELECTROENCEPHALOGRAPHY; HUMANS; HYPNOTICS AND SEDATIVES; INTENSIVE CARE UNITS; MONITORING, PHYSIOLOGIC; PAIN MEASUREMENT;

EID: 45949084757     PISSN: 13648535     EISSN: 1466609X     Source Type: Journal    
DOI: 10.1186/cc6818     Document Type: Review

References (90)

1. Jacobi J Fraser GL Coursin DB Riker RR Fontaine D Wittbrodt ET Chalfin DB Masica MF Bjerke HS Coplin WM Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult Crit Care Med 2002, 30:119-141. 10.1097/00003246-200201000-00020 11902253
2. Sessler CN Grap MJ Brophy GM Multidisciplinary management of sedation and analgesia in critical care Semin Respir Crit Care Med 2001, 22:211-225. 10.1055/s-2001-13834 16088675
3. Riker RR Fraser GL Monitoring sedation, agitation, analgesia, neuromuscular blockade, and delirium in adult ICU patients Semin Respir Crit Care Med 2001, 22:189-198. 10.1055/s-2001-13832 16088673
4. Kress JP Hall JB Sedation in the mechanically ventilated patient Crit Care Med 2006, 34:2541-2546. 10.1097/01.CCM.0000239117.39890.E3 16932231
5. Hamill-Ruth RJ Marohn ML Evaluation of pain in the critically ill patient Crit Care Clin 1999, 15:35-54, v-vi. 10.1016/ S0749-0704(05)70038-5 9929785
6. Puntillo KA Pain experiences of intensive care unit patients Heart Lung 1990, 19:526-533. 2211161
7. Puntillo K Stitch, stitch... creating an effective pain management program for critically ill patients Am J Crit Care 1997, 6:259-260. 9215421
8. Puntillo KA Wild LR Morris AB Stanik-Hutt J Thompson CL White C Practices and predictors of analgesic interventions for adults unQergoing painful procedures Am J Crit Care 2002, 11:415-429: quiz 430-431. 12233967
9. Desbiens NA Wu AW Broste SK Wenger NS Connors AF Jr Lynn J Yasui Y Phillips RS Fulkerson W Pain and satisfaction with pain control in seriously ill hospitalized adults: Findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment Crit Care Med 1996, 24:1953-1961. 10.1097/00003246-199612000-00005 8968261
10. McArdle P Intravenous analgesia Crit Care Clin 1999, 15:89-104. 10.1016/ S0749-0704(05)70041-5 9929788
11. Herr K Coyne PJ Key T Manworren R McCaffery M Merkel S Pelosi-Kelly J Wild L Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations Pain Manag Nurs 2006, 7:44-52. 10.1016/ j.pmn.2006.02.003 16730317
12. Hadjistavropoulos T LaChapelle DL Hadjistavropoulos HD Green S Asmundson GJ Using facial expressions to assess musculoskeletal pain in older persons Eur J Pain 2002, 6:179-187. 10.1053/eujp.2001.0327 12036305
13. Puntillo KA Miaskowski C Kehrle K Stannard D Gleeson S Nye P Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration Crit Care Med 1997, 25:1159-1166. 10.1097/00003246-199707000-00017 9233742
14. Acute Pain Management Guideline Panel Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline. AHCPR Publication No. 92-0032 Rockville, MD: Agency for Health Care Policy and Research 1992.
15. Payen JF Bru O Bosson JL Lagrasta A Novel E Deschaux I Lavagne P Jacquot C Assessing pain in critically ill sedated patients by using a behavioral pain scale Crit Care Med 2001, 29:2258-2263. 10.1097/ 00003246-200112000-00004 11801819
16. Mularski RA Pain management in the intensive care unit Crit Care Clin 2004, 20:381-401, viii. 10.1016/j.ccc.2004.03.010 15183209
17. Gelinas C Fortier M Viens C Fillion L Puntillo K Pain assessment and management in critically ill intubated patients: A retrospective study Am J Crit Care 2004, 13:126-135. 15043240
18. Payen JF Chanques G Mantz J Hercule C Auriant I Leguillou JL Binhas M Genty C Rolland C Bosson JL Current practices in sedation and analgesia for mechanically ventilated critically ill patients: A prospective multicenter patient-based study Anesthesiology 2007, 106:687-695. 10.1097/01.anes.0000264747.09017.da 17413906
19. Shapiro BA Warren J Egol AB Greenbaum DM Jacobi J Nasraway SA Schein RM Spevetz A Stone JR Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: An executive summary. Society of Critical Care Medicine Crit Care Med 1995, 23:1596-1600. 10.1097/00003246-199509000-00021 7664563
20. Herr KA Spratt K Mobily PR Richardson G Pain intensity assessment in older adults: Use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults Clin J Pain 2004, 20:207-219. 10.1097/00002508-200407000-00002 15218405
21. Spadoni GF Stratford PW Solomon PE Wishart LR The evaluation of change in pain intensity: A comparison of the P4 and single-item numeric pain rating scales J Orthop Sports Phys Ther 2004, 34:187-193. 10.1016/ j.bone.2003.04.002 15128188
22. Cepeda MS Africano JM Polo R Alcala R Carr DB Agreement between percentage pain reductions calculated from numeric rating scores of pain intensity and those reported by patients with acute or cancer pain Pain 2003, 106:439-442. 10.1016/j.pain.2003.09.006 14659527
23. Bergh I Sjostrom B Oden A Steen B An application of pain rating scales in geriatric patients Aging (Milano) 2000, 12:380-387. 11126525
24. Puntillo KA White C Morris AB Perdue ST Stanik-Hutt J Thompson CL Wild LR Patients' perceptions and responses to procedural pain: Results from Thunder Project II Am J Crit Care 2001, 10:238-251. 11432212
25. Ambuel B Hamlett KW Marx CM Blumer JL Assessing distress in pediatric intensive care environments: The COMFORT scale J Pediatr Psychol 1992, 17:95-109. 10.1093/jpepsy/17.1.95 1545324
26. De Jonghe B Cook D Appere-De-Vecchi C Guyatt G Meade M Outin H Using and understanding sedation scoring systems: A systematic review Intensive Care Med 2000, 26:275-285. 10.1007/s001340051150 10823383
27. Merkel SI Voepel-Lewis T Shayevitz JR Malviya S The FLACC: A behavioral scale for scoring postoperative pain in young children Pediatr Nurs 1997, 23:293-297. 9220806
28. Manworren RC Hynan LS Clinical validation of FLACC: Preverbal patient pain scale Pediatr Nurs 2003, 29:140-146. 12723828
29. Merkel S Pain assessment in infants anf young children: The Finger Span Scale Am J Nurs 2002, 102:55-56.
30. Young J Siffleet J Nikoletti S Shaw T Use of a Behavioural Pain Scale to assess pain in ventilated, unconscious and/or sedated patients Intensive Crit Care Nurs 2006, 22:32-39. 10.1016/j.iccn.2005.04.004 16198570
31. Chanques G Jaber S Barbotte E Violet S Sebbane M Perrigault PF Mann C Lefrant JY Eledjam JJ Impact of systematic evaluation of pain and agitation in an intensive care unit Crit Care Med 2006, 34:1691-1699. 10.1097/01.CCM.0000218416.62457.56 16625136
32. Odhner M Wegman D Freeland N Steinmetz A Ingersoll GL Assessing pain control in nonverbal critically ill adults Dimens Crit Care Nurs 2003, 22:260-267. 10.1097/00003465-200311000-00010 14639117
33. Mateo OM Krenzischek DA A pilot study to assess the relationship between behavioral manifestations and self-report of pain in postanesthesia care unit patients J Post Anesth Nurs 1992, 7:15-21. 1531235
34. Gelinas C Fillion L Puntillo KA Viens C Fortier M Validation of the criticalcare pain observation tool in adult patients Am J Crit Care 2006, 15:420-427. 16823021
35. Ramsay MA Savege TM Simpson BR Goodwin R Controlled sedation with alphaxalone-alphadolone BMJ 1974, 2:656-659. 1613102 4835444
36. Riker RR Picard JT Fraser GL Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients Crit Care Med 1999, 27:1325-1329. 10.1097/00003246-199907000-00022 10446827
37. Devlin JW Boleski G Mlynarek M Nerenz DR Peterson E Jankowski M Horst HM Zarowitz BJ Motor Activity Assessment Scale: A valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit Crit Care Med 1999, 27:1271-1275. 10.1097/ 00003246-199907000-00008 10446819
38. de Lemos J Tweeddale M Chittock D Measuring quality of sedation in adult mechanically ventilated critically ill patients. the Vancouver Interaction and Calmness Scale. Sedation Focus Group J Clin Epidemiol 2000, 53:908-919. 10.1016/S0895-4356(00)00208-0 11004417
39. Sessler CN Gosnell MS Grap MJ Brophy GM O'Neal PV Keane KA Tesoro EP Elswick RK The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients Am J Respir Crit Care Med 2002, 166:1338-1344. 10.1164/rccm.2107138 12421743
40. De Jonghe B Cook D Griffith L Appere-de-Vecchi C Guyatt G Theron V Vagnerre A Outin H Adaptation to the Intensive Care Environment (ATICE): development and validation of a new sedation assessment instrument Crit Care Med 2003, 31:2344-2354. 10.1097/01.CCM.0000084850.16444.94 14501966
41. Weinert C McFarland L The state of intubated ICU patients: Development of a two-dimensional sedation rating scale for critically ill adults Chest 2004, 126:1883-1890. 10.1378/chest.126.6.1883 15596688
42. Sessler CN Use of sedation assessment scales in the ICU: Paying attention to what we are doing Proceedings of the 6th Conference of the Center for Medication Safety and Clinical Improvement: 17 to 18 November 2005 San Diego, CA: Center for Medication Safety and Clinical Improvement 2005:P6-P10. http://www.cardinal.com/clinicalcenter/ materials/conferences/SedationProceedings.pdf
43. Sessler CN Sedation scales in the ICU Chest 2004, 126:1727-1730. 10.1378/ chest.126.6.1727 15596665
44. Magarey JM Sedation of adult critically ill ventilated patients in intensive care units: A national survey Aust Crit Care 1997, 10:90-93. 10.1016/S1036-7314(97)70406-5 9362609
45. Soliman HM Melot C Vincent JL Sedative and analgesic practice in the intensive care unit: The results of a European survey Br J Anaesth 2001, 87:186-192. 10.1093/bja/87.2.186 11493487
46. Rhoney DH Murry KR National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit J Intensive Care Med 2003, 18:139-145. 10.1177/0885066603251200 14984632
47. Samuelson KA Larsson S Lundberg D Fridlund B Intensive care sedation of mechanically ventilated patients: A national Swedish survey Intensive Crit Care Nurs 2003, 19:350-362. 10.1016/S0964-3397(03)00065-X 14637295
48. Guldbrand P Berggren L Brattebo G Malstam J Ronholm E Winso O Survey of routines for sedation of patients on controlled ventilation in Nordic intensive care units Acta Anaesthesiol Scand 2004, 48:944-950. 10.1111/ j.1399-6576.2004.00445.x 15315610
49. Botha J Le Blanc V The state of sedation in the nation: Results of an Australian survey Crit Care Resusc 2005, 7:92-96. 16548799
50. Mehta S Burry L Fischer S Martinez-Motta JC Hallett D Bowman D Wong C Meade MO Stewart TE Cook DJ Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients Crit Care Med 2006, 34:374-380. 10.1097/01.CCM.0000196830.61965.F1 16424717
51. Fraser GL Prato BS Riker RR Berthiaume D Wilkins ML Frequency, severity, and treatment of agitation in young versus elderly patients in the ICU Pharmacotherapy 2000, 20:75-82. 10.1592/phco.20.1.75.34663 10641977
52. Woods JC Mion LC Connor JT Viray F Jahan L Huber C McHugh R Gonzales JP Stoller JK Arroliga AC Severe agitation among ventilated medical intensive care unit patients: Frequency, characteristics and outcomes Intensive Care Med 2004, 30:1066-1072. 10.1007/s00134-004-2193-9 14966671
53. Carrion MI Ayuso D Marcos M Paz Robles M de la Cal MA Alia I Esteban A Accidental removal of endotracheal and nasogastric tubes and intravascular catheters Crit Care Med 2000, 28:63-66. 10.1097/ 00003246-200001000-00010 10667500
54. Cohen IL Gallagher TJ Pohlman AS Dast JF Abraham E Papadakos PJ The management of the agitated ICU patient Crit Care Med 2002, 30:S97-S125. 10.1097/00003246-200201002-00001
55. Fraser GL Riker RR Prato BS Wilkins ML The frequency and cost of patient-initiated device removal in the ICU Pharmacotherapy 2001, 21:1-6. 10.1592/phco.21.1.1.34444 11191727
56. Sessler CN Glass C Grap MJ Unplanned extubation: Incidence, predisposing factors, and management J Crit Illness 1994, 9:609-619.
57. De Jonghe B Bastuji-Garin S Fangio P Lacherade JC Jabot J Appere-De-Vecchi C Rocha N Outin H Sedation algorithm in critically ill patients without acute brain injury Crit Care Med 2005, 33:120-127. 10.1097/01.CCM.0000150268.04228.68 15644658
58. Ely EW Truman B Shintani A Thomason JW Wheeler AP Gordon S Francis J Speroff T Gautam S Margolin R Monitoring sedation status over time in ICU patients: Reliability and validity of the Richmond Agitation-Sedation Scale (RASS) JAMA 2003, 289:2983-2991. 10.1001/ jama.289.22.2983 12799407
59. Brandl KM Langley KA Riker RR Dork LA Quails CR Levy H Confirming the reliability of the sedation-agitation scale administered by ICU nurses without experience in its use Pharmacotherapy 2001, 21:431-436. 10.1592/ phco.21.5.431.34487 11310516
60. Hogg LH Bobek MB Mion LC Legere BM Banjac S VanKerkhove K Arroliga AC Interrater reliability of 2 sedation scales in a medical intensive care unit: A preliminary report Am J Crit Care 2001, 10:79-83. 11244675
61. Riker RR Fraser GL Simmons LE Wilkins ML Validating the Sedation-Agitation Scale with the Bispectral Index and visual analog scale in adult ICU patients after cardiac surgery Intensive Care Med 2001, 27:853-858. 10.1007/s001340100912 11430541
62. Grap MJ Borchers CT Munro CL Elswick RK Jr Sessler CN Actigraphy in the critically ill: Correlation with activity, agitation, and sedation Am J Crit Care 2005, 14:52-60. 15608109
63. Mondello E Siliotti R Noto G Cuzzocrea E Scollo G Trimarchi G Venuti FS Bispectral Index in ICU: Correlation with Ramsay Score on assessment of sedation level J Clin Monit Comput 2002, 17:271-277. 10.1023/ A:1021250320103 12546259
64. Tonner PH Wei C Bein B Weiler N Paris A Scholz J Comparison of two bispectral index algorithms in monitoring sedation in postoperative intensive care patients Crit Care Med 2005, 33:580-584. 10.1097/ 01.CCM.0000156291.04287.7F 15753750
65. Simmons LE Riker RR Prato BS Fraser GL Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale Crit Care Med 1999, 27:1499-1504. 10.1097/ 00003246-199908000-00016 10470756
66. Nasraway SS Jr Wu EC Kelleher RM Yasuda CM Donnelly AM How reliable is the Bispectral Index in critically ill patients? A prospective, comparative, single-blinded observer study Crit Care Med 2002, 30:1483-1487. 10.1097/00003246-200207000-00014 12130966
67. de Wit M Epstein SK Administration of sedatives and level of sedation: comparative evaluation via the Sedation-Agitation Scale and the Bispectral Index Am J Crit Care 2003, 12:343-348. 12882065
68. Deogaonkar A Gupta R Degeorgia M Sabharwal V Gopakumaran B Schubert A Provencio JJ Bispectral Index monitoring correlates with sedation scales in brain-injured patients Crit Care Med 2004, 32:2403-2406. 10.1097/ 01.CCM.0000147442.14921.A5 15599143
69. Ely EW Truman B Manzi DJ Sigl JC Shintani A Bernard GR Consciousness monitoring in ventilated patients: Bispectral EEG monitors arousal not delirium Intensive Care Med 2004, 30:1537-1543. 10.1007/ s00134-004-2298-1 15127189
70. Chase JG Agogue F Starfinger C Lam Z Shaw GM Rudge AD Sirisena H Quantifying agitation in sedated ICU patients using digital imaging Comput Methods Programs Biomed 2004, 76:131-141. 10.1016/ j.cmpb.2004.03.005 15451162
71. Costa J Cabre L Molina R Carrasco G Cost of ICU sedation: Comparison of empirical and controlled sedation methods Clin Intensive Care 1994, 5(Suppl):17-21.
72. Botha JA Mudholkar P The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit Crit Care Resusc 2004, 6:253-257. 16556102
73. Gibbs F Gibbs E Lennox W Effect on the electroencephalogram of certain drugs which influence nervous activity Arch Intern Med 1937, 60:154-166.
74. Maynard D Prior PF Scott DF Device for continuous monitoring of cerebral activity in resuscitated patients BMJ 1969, 4:545-546. 1630343 5354856
75. Myles PS Leslie K McNeil J Forbes A Chan MT Bispectral index monitoring to prevent awareness during anaesthesia: The B-Aware randomised controlled trial Lancet 2004, 363:1757-1763. 10.1016/ S0140-6736(04)16300-9 15172773
76. Drover D Ortega HR Patient state index Best Pract Res Clin Anaesthesiol 2006, 20:121-128. 10.1016/j.bpa.2005.07.008 16634419
77. Cortinez LI Delfino AE Fuentes R Munoz HR Performance of the Cerebral State Index during increasing levels of propofol anesthesia: A comparison with the Bispectral Index Anesth Analg 2007, 104:605-610. 10.1213/01.ane.0000255152.96354.17 17312217
78. Kreuer S Wilhelm W Grundmann U Larsen R Bruhn J Narcotrend Index versus Bispectral Index as electroencephalogram measures of anesthetic drug effect during propofol anesthesia Anesth Analg 2004, 98:692-697. 10.1213/ 01.ANE.0000103182.78466.EF 14980921
79. Viertio-Oja H Maja V Sarkela M Talja P Tenkanen N Tolvanen-Laakso H Paloheimo M Vakkuri A Yli-Hankala A Merilainen P Description of the entropy algorithm as applied in the Datex-Ohmeda S/5 Entropy Module Acta Anaesthesiol Scand 2004, 48:154-161. 10.1111/j.0001-5172.2004.00322.x 14995936
80. Bruhn J Bouillon TW Radulescu L Hoeft A Bertaccini E Shafer SL Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of 'anesthetic depth' during coadministration of propofol and remifentanil Anesthesiology 2003, 98:621-627. 10.1097/00000542-200303000-00008 12606904
81. Takamatsu I Ozaki M Kazama T Entropy indices vs the bispectral index for estimating nociception during sevoflurane anaesthesia Br J Anaesth 2006, 96:620-626. 10.1093/bja/ael050 16531443
82. Struys MM Jensen EW Smith W Smith NT Rampil I Dumortier FJ Mestach C Mortier EP Performance of the ARX-derived auditory evoked potential index as an indicator of anesthetic depth; a comparison with bispectral index and hemodynamic measures during propofol administration Anesthesiology 2002, 96:803-816. 10.1097/00000542-200204000-00006 11964586
83. Anderson RE Barr G Jakobsson JG Correlation beween AAI-index and the BIS-index during propofol hypnosis: A clinical study J Clin Monit Comput 2002, 17:325-329. 10.1023/A:1024283303023 12885175
84. LeBlanc JM Dasta JF Kane-Gill SL Role of the bispectral index in sedation monitoring in the ICU Ann Pharmacother 2006, 40:490-500. 10.1345/aph.1E491 16492796
85. Vivien B Di Maria S Ouattara A Langeron O Coriat P Riou B Overestimation of Bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant Anesthesiology 2003, 99:9-17. 10.1097/ 00000542-200307000-00006 12826836
86. Dasta JF Kane SL Gerlach AT Cook CH Bispectral Index in the intensive care setting Crit Care Med 2003, 31:998. author reply 998-999. 10.1097/ 01.CCM.0000055393.30990.1E 12627033
87. Gan TJ Glass PS Windsor A Payne F Rosow C Sebel P Manberg P Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group Anesthesiology 1997, 87:808-815. 10.1097/00000542-199710000-00014 9357882
88. Riker RR Fraser GL Wilkins ML Comparing the bispectral index and suppression ratio with burst suppression of the electroencephalogram during pentobarbital infusions in adult intensive care patients Pharmacotherapy 2003, 23:1087-1093. 10.1592/phco.23.10.1087.32766 14524640
89. Ramsay M Role of brain function monitoring in the critical care and perioperative settings Semin Anesth Periop Med Pain 2005, 24:195-202. 10.1053/j.sane.2005.10.002
90. Pun BT Gordon SM Peterson JF Shintani AK Jackson JC Foss J Harding SD Bernard GR Dittus RS Ely EW Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers Crit Care Med 2005, 33:1199-1205. 10.1097/ 01.CCM.0000166867.78320.AC 15942331