CARING FOR THE CRITICALLY ILL PATIENT Monitoring Sedation Status Over Time in ICU Patients Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS)

INCREASED SCRUTINY HAS RECENTLY been placed on appropriate titration of sedative and analgesic medications in critically ill patients, especially those being treated with mechanical ventilation. Patient comfort should be a primary goal in the intensive care unit (ICU), including adequate pain control, anxiolysis, and prevention and treatment of delirium. However, achieving an appropriate balance of sedation and analgesia is challenging. Without rational and agreed on target levels of sedation, different members of the health care team will have disparate treatment goals, increasing the chance for iatrogenic complications and potentially impeding recovery. The clinical practice guidelines of the Society of Critical Care Medicine emphasize the need for goal-directed delivery of psychoactive medications. AlAuthor Affiliations are listed at the end of this article. Corresponding Author and Reprints: E. Wesley Ely, MD, MPH, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research of Vanderbilt University, Tennessee Valley Veteran’s Affairs Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, TN 37232 (e-mail: wes [email protected]). Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA. Advisory Board: David Bihari, MD; Christian BrunBuisson, MD; Timothy Evans, MD; John Heffner, MD; Norman Paradis, MD; Adrienne Randolph, MD. Context Goal-directed delivery of sedative and analgesic medications is recommended as standard care in intensive care units (ICUs) because of the impact these medications have on ventilator weaning and ICU length of stay, but few of the available sedation scales have been appropriately tested for reliability and validity.