Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Aim: To examine the effect of sedation level on sedation outcomes
of physiologic stability and comfort.
Methods: Twenty-four subjects in the Medical Respiratory ICU were
continuously monitoring and data recorded every 15 seconds (326
patient hours). Sedation level was measured with the Patient State
Index (PSI; processed EEG), physiologic stability was documented
using heart rate (HR) and respiratory rate (RR), comfort was
evaluated using arm and leg actigraphy, a method to detect patient
movement. All data were downloaded for analysis and the percent
of time outside normal range for HR, RR and actigraphy were
evaluated. Sedation level was categorized as deep (PSI < 60),
mild/moderate (PSI 60-80) or awake/alert (PSI > 80).
Findings: Subjects were predominantly female (73%), with a mean
age of 55, and admitted for acute respiratory failure. Subjects were
identified as physiologically unstable (either HR or RR outside of
normal limits) 65% of the time during deep sedation, 62% during
mild/moderate sedation and 60% when alert. Percent of time of
patient was moving, which may indicate discomfort, was 2% during
deep sedation, 10% during mild/moderate sedation and 13% while
alert.
Conclusions: Although patient movement increases as expected
with less sedation, physiologic stability is not being achieved more
than half the time, even with deep levels of sedation. The present
methods of sedation evaluation may not adequately assess all
domains of sedation efficacy.
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