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videnSkab Sygepleje
vurderingsredskab der bør anvendes. RASS forekommer at være
det bedst egnede, idet patienterne ikke påføres smertefulde stimuli,
og et eventuelt agitationsniveau nuanceres. Der er ej heller
konsensus om, hvor hyppigt og til hvilke patientgrupper sedationsvurdering
anvendes. Emnet er klinisk relevant, idet nyere
studier tyder på, at sedation og specielt oversedering har en
række ugunstige effekter.
Deliriumvurdering udføres sjældent og særdeles sjældent systematisk.
Kun i fem afdelinger vurderes patienterne systematisk
ved hjælp af CAM-ICU. Under halvdelen af afdelingerne har en
instruks for behandling af delirium. Det forekommer, at klinisk
praksis vedrørende sedations- og deliriumvurdering af patienter
på de intensive afdelinger kan forbedres, og en stor del af afdelingerne
er tilsyneladende klar til at sætte fokus på området.
74 SygeplejerSken 15.2011
Helle Svenningsen er ph.d.-studerende og
tilknyttet Anæstesiologisk afdeling,
Århus Universitetshospital, Århus Sygehus;
hellsven@rm.dk
Else Tønnesen er overlæge samme sted.
Litteratur
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English abstract
Svenningsen H, Tønnesen E. Assessment of sedation and delirium
on Danish intensive care units.
Sygeplejersken 2011(15):69-74.
Background: Critically ill patients who develop delirium experience
longer stays in intensive care as well as increased morbidity
and mortality. Assessing a patient’s level of delirium also
requires assessment of the level of consciousness, since changes
in the latter are signs of delirium.
The aim of this questionnaire was to highlight clinical practice
in respect of assessing sedation and symptoms of delirium
in intensive care patients. Based on the results received, various
tools for assessing sedation are discussed.
Method: In May 2009 the questionnaire was issued via email
to 46 intensive care units caring for ventilated adult patients.
An intensive care nurse with daily patient contact was asked to
describe the unit’s practice in respect of sedation and delirium
assessment tools in adult patients.
Results: The questionnaires show that patients’ level of sedation
is almost always assessed on Danish intensive care units.
There was no consensus on which tool was used to assess sedation,
the frequency of assessment, or on which patient groups
such tools are used. The field is clinically relevant since recent
studies suggest that sedation, and in particular over-sedation,
has a number of adverse effects.
Assessment of delirium is performed rarely, and rarely systematically.
Only five units assessed patients systematically using
CAM-ICU. Less than half of the units have a protocol for treatment
of delirium.
Key words: sedation; delirium; scoring; RASS; CAM-ICU; critically
ill; intensive care nursing.
13. Devlin JW, Boleski G, Mlynarek M, Nerenz DR, Peterson E, Jankowski
M et al. 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
Jul;27(7):1271-5.
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Scale for adult critically ill patients. Crit Care
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KA et al. The Richmond Agitation-Sedation Scale: Validity and
Reliability in Adult Intensive Care Unit Patients. Am J Respir Crit
Care Med 2002 Nov 15;166(10):1338-44.
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weaning protocol for mechanically ventilated patients in intensive
care (Awakening and Breathing Controlled trial): a randomised
controlled trial. Lancet 2008 Jan 12;371(9607):126-34.
19. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon
S et al. Monitoring sedation status over time in ICU patients:
reliability and validity of the Richmond Agitation-Sedation Scale
(RASS). JAMA 2003 Jun 11;289(22):2983-91.