Sedation Assessment in Critically Ill Adults: 2001-2004 Update

OBJECTIVE To review recently published literature on the validity and reliability of sedation assessment tools in critically ill adults and evaluate the potential advantages and disadvantages of each. DATA SOURCES A computerized search of MEDLINE and PubMed (2001–May 2004) was conducted. STUDY SELECTION AND DATA EXTRACTION Sedation assessment tools used in adult intensive care units (ICUs) were identified. DATA SYNTHESIS Six subjective and 3 objective assessment tools were identified. Four subjective assessment tools have reliability and 4 have validity data published that were not previously available. There are reliability data to further support the use of the previously published Motor Activity Assessment Scale. Additional reliability data exist for the Ramsay Scale and Glasgow Coma Scale. Conflicting evidence is available with the use of the Bispectral Index monitor in the ICU. Recently, the Patient State Index and Auditory Evoked Potentials were introduced for objective monitoring in critically ill patients. CONCLUSIONS Increasing data on sedation assessment were published over the last few years, probably in response to supporting evidence that goal-driven sedation therapy improves patient outcomes. Reliability and/or validity testing exists for many of these scales. Several useful tools are available to guide sedation therapy in critically ill patients.