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Obtaining a RASS score is the first step in administering the Confusion Assessment Method in the ICU (CAM-ICU), [4] a tool to detect delirium in intensive care unit patients. The RASS is one of many sedation scales used in medicine. Other scales include the Ramsay scale, the Sedation-Agitation-Scale, and the COMFORT scale for pediatric patients.
Brain disruption from sedation can lead to an eight times [4] increased risk of the development of ICU delirium. This is associated with a doubled risk of mortality [5] during hospital admission. For every one day of delirium, there is a 10% increased risk of death. [6]
Sedation scales are used in medical situations in conjunction with a medical history in assessing the applicable degree of sedation in patients in order to avoid under-sedation (the patient risks experiencing pain or distress) and over-sedation (the patient risks side effects such as suppression of breathing, which might lead to death).
Studies suggest dexmedetomidine for sedation in mechanically ventilated adults may reduce time to extubation and ICU stay. [13] [14] Compared with other sedatives, some studies suggest dexmedetomidine may be associated with less delirium. [15] However, this finding is not consistent across multiple studies. [14]
ICU-acquired weakness (ICU-AW), sometimes called critical illness polyneuropathy, is the most common form of physical impairment, and is estimated to occur in 25 percent or more of ICU survivors. [12] [13] It is thought to be an effect of long-term immobility and deep sedation that many critically ill patients experience while in the ICU. [4]
This level, called moderate sedation/analgesia or conscious sedation, causes a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied with light physical stimulation. Breathing tubes are not required for this type of anesthesia. This is twilight anesthesia. [2]
The original scoring system was developed before the invention of pulse oximetry and used the patient's colouration as a surrogate marker of their oxygenation status. A modified Aldrete scoring system was described in 1995 [2] which replaces the assessment of skin colouration with the use of pulse oximetry to measure SpO 2.
model to assess risk of death at ICU admission; has prediction models for assessment at admittance, 24h, 48h and 72h after; RIFLE - Risk, injury, failure, loss and end-stage kidney classification [2] has 3 severity levels (risk, injury and failure) and 2 possible outcomes (loss and end-stage) CP - Child–Pugh score [2] for patient with liver ...