Sedation management in the mechanically ventilated critically ill patient

The Richmond Agitation-Sedation Scale: translation and reliability testing in a Swedish intensive care unit

BACKGROUND

Awareness about adequate sedation in mechanically ventilated patients has increased in recent years. The use of a sedation scale to continually evaluate the patient's response to sedation may promote earlier extubation and may subsequently have a positive effect on the length of stay in the intensive care unit (ICU). The Richmond Agitation-Sedation Scale (RASS) provides 10 well-defined levels divided into two different segments, including criteria for levels of sedation and agitation. Previous studies of the RASS have shown it to have strong reliability and validity. The aim of this study was to translate the RASS into Swedish and to test the inter-rater reliability of the scale in a Swedish ICU.

METHODS

A translation of the RASS from English into Swedish was carried out, including back-translation, critical review and pilot testing. The inter-rater reliability testing was conducted in a general ICU at a university hospital in the south of Sweden, including 15 patients mechanically ventilated and sedated. Forty in-pair assessments using the Swedish version of the RASS were performed and the inter-rater reliability was tested using weighted kappa statistics (linear weighting).

RESULT

The translation of the RASS was successful and the Swedish version was found to be satisfactory and applicable in the ICU. When tested for inter-rater reliability, the weighed kappa value was 0.86.

CONCLUSION

This study indicates that the Swedish version of the RASS is applicable with good inter-rater reliability, suggesting that the RASS can be useful for sedation assessment of patients mechanically ventilated in Swedish general ICUs.

The meaning of family members' presence during intensive care stay: a qualitative study

The aim of this study was to investigate what the presence of family members meant to patients in intensive care units. The study employed a qualitative approach with semi-structured interviews and qualitative content analysis. Eleven intensive care patients were interviewed at a university hospital in Norway. The results of the study indicated that the patients desired some limitation of visitors' presence and preferred visits only from those who were closest in daily life. Visits had a variety of functions for intensive care patients, including promoting support for patients and families. However, visits also caused stress for patients and worries about creating stress for family members. The patients' requirements for information differed. The findings suggest that information to the families is important for the patients need for reality orientation. Visits in intensive care units and information to the families have mutual importance for the patients and their families. The study supports prior claims that flexible visiting routines are challenging for ICU nurses. A dialogue with the families is recommended in order to find a balance between the social support and the stress caused by visits. This puts the families in a better position to give support to the patients during recovery.