|
SCORES DE SEDATION |
| Voici 4 scores de sédation dont les propriétés ont été correctement étudiées et qui peuvent être utilisés en routine ou dans une étude sur la sédation. | |
| Ramsay Scale | |
| Awake levels | |
| patient anxious or agitated or both | 1 |
| patient co-operative, orientated and tranquil | 2 |
| patient responds to commands only | 3 |
| Asleep levels : | |
| a brisk response to a light glabellar tap | 4 |
| a sluggish response to a light glabellar tap | 5 |
| no response | 6 |
|
Echelle de sédation très employées en France car très simple Reproductibilité très correcte (Kappa: 0.79 à 0.87) validité testée contre le S.A.S. References: Ramsay et al - 1974. Controlled sedation with Alaphalone-alphadolone. BMJ ii:656 | |
| Comfort Scale | |
| Altertness : | |
| Deeply asleep | 1 |
| Lightly asleep | 2 |
| Drowsy | 3 |
| Fully awake and alert | 4 |
| Hyper-alert | 5 |
| Calmness/Agitation : | |
| Calm | 1 |
| Slightly anxious | 2 |
| Anxious | 3 |
| Very anxious | 4 |
| Panicky | 5 |
| Respiratory response : | |
| No coughing and no spontaneous respiration | 1 |
| Spontaneous respiration with little or no response to ventilation | 2 |
| Occasional cough or resistance to ventilator | 3 |
| Actively breathes against ventilator or coughs regularly | 4 |
| Fights ventilator; coughing or choking | 5 |
| Physical movement : | |
| No movement | 1 |
| Occasional, slight movement | 2 |
| Frequent, slight movement | 3 |
| Vigorous movement limited to extremities | 4 |
| Vigorous movement including torso and head | 5 |
| Blood pressure : | |
| Blood pressure below baseline | 1 |
| Blood pressure consistently at baseline | 2 |
| Infrequent elevations of 15 % or more (1-3 episodes) | 3 |
| Frequent elevations of 15 % or more (more than 3 episodes) | 4 |
| Sustained elevation ≥ 15 % | 5 |
| Heart rate : | |
| Heart rate below baseline | 1 |
| Heart rate consistently at baseline | 2 |
| Infrequent elevations of 15 % or more (1-3 episodes) | 3 |
| Frequent elevations of 15 % or more (more than 3 episodes) | 4 |
| Sustained elevation ≥ 15 % | 5 |
| Muscle tone : | |
| Muscle totally relaxed | 1 |
| Reduced muscle tone | 2 |
| Normal muscle tone | 3 |
| Increased muscle tone and flexion of fingers and toes | 4 |
| Extreme muscle rigidity and flexion of fingers and toes | 5 |
| Facial tension : | |
| Facial muscle totally relaxed | 1 |
| Facial muscle tone normal; no facial muscle tension evident | 2 |
| Tension evident in some facial muscles | 3 |
| Tension evident throughout facial muscles | 4 |
| Facial muscles contorted and grimacing | 5 |
|
Echelle plus compexe utilisée en pédiatrie Validée vs experts Bonne reproductibilité Sensibilité aux changements non testée References: Ambuel et al - 1992- Assessing distress in pediatric intensive care environments: The COMFORT scale- J Pediatr Psychol 17:95-109 | |
| Sedation - Agitation Scale (SAS) | |
| Dangerous agitation. Pulling at ET tube, trying to remove catheters, climbing over bed rail, striking at staff, trashing side-to-side | 7 |
| Very agitated. Does not calm, despite frequent verbal reminding of limits, requires physical restraints, biting ET tube | 6 |
| Agitated. Anxious or mildly agitated, attempting to sit up, calms down to verbal instructions | 5 |
| Calm and co-operative. Calm, awakens easily, follows command | 4 |
| Sedated. Difficult to arouse, awakens to verbal stimuli or gentle shaking but drifts off again, follows simple commands | 3 |
| Very sedated. Arouses to physical stimuli but does not communicate or follows command, may move spontaneously | 2 |
| Unrousable. Minimal or no response to noxious stimuli, does not communicate or follows command | 1 |
|
Echelle assez proche du Ramsay. Excellente reproductibilité (Kappa 0.91) . Validité testée face au Ramsay et à l'echelle de Harris. Reference: Riker et al - 1994- Continuous infusion of haloperidol controls agitation in critically ill patients - Crit Care med 22:433-40 | |
| Motor Activity Assessment Scale (MAAS) | |
| Unresponsive. Does not move with noxious stimulus | 0 |
| Responsive only to noxious stimuli. Open eyes OR raises eyebrows OR turns toward stimulus OR moves limb with noxious stimulus | 1 |
| Responsive to touch or name. Open eyes OR raises eyebrows OR turns head toward stimulus OR moves limb when touched or name is loudly spoken | 2 |
| Calm and co-operative. No external stimulus is required to elicit movement AND patient is follows command | 3 |
| Restless and co-operative. No external stimulus is required to elicit movement AND patient is picking at sheets or tubes OR uncovering self and follows command | 4 |
| Agitated. No external stimulus is required to elicit movement AND attempting to sit up OR moves limbs out follow commands (e. g. ; will lie down when asked but soon reverts back to attempts to sit up or move limbs out of bed) | 5 |
| Dangerously agitated, uncooperative. No external stimulus is required to elicit movement AND patient is pulling at tubes or catheters OR trashing side to side OR striking at staff OR trying to climb out of bed AND does not calm down when asked | 6 |
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Echelle tres proche de la précédente. Reproductibilité testée sur 400 paires de mesure (Kappa 0.83) validité bien testée face aux experts. Sensibilité aux changements non testée Reference: Devlin et al - 1999; Motor activity assessment scale for use with mechalichally ventilated patients in an adult intensive care unit - Crit care Med 27:1271-5 A lire pour des références supplémentaires et une bonne revue des propriétés des score existants: De Jonghe et al - Using and understanding sedation scoring systems : a systematic review - Intensive Care Med 2000;26:275-285 | |