Alcohol Withdrawal
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
While a majority of individuals experience only minor, uncomplicated withdrawal symptoms, such as increased anxiety, headache, nausea, vomiting, insomnia, and mild tremors, which self-resolve, a small subgroup of these individuals experience a more complicated syndrome that includes hallucinations, seizures, delirium, and/or more severe autonomic hyperactivity. Patients with such severe symptoms usually require intensive care unit (ICU) admission. The Revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) is one of the most commonly used tools to address withdrawal severity as well as treatment effects amongst these patients. It is a 10-item scale that tracks the degree of nausea and vomiting, headache, tremor, diaphoresis, anxiety, agitation, disorientation, and auditory, visual, and tactile disturbances [3]. The CIWA-Ar scale requires patient interaction to accurately assess patient symptomology and allow active medication titration. The scale is used for its therapeutic use as it can be continued throughout the withdrawal process. Other scales such as the Riker Sedation-Agitation scale and Richmond Agitation-Sedation scale can be used for patients that require mechanical ventilation or are unable to communicate [1].
Pediatric ICU management
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Management of mental status, sedation, and anxiety begins with frequent and consistent assessment using tools such as the State Behavioral Scale and the Richmond Agitation-Sedation Scale, among others, that have been developed, validated, and incorporated into sedation assessment and management protocols [61–63]. Short- and long-acting benzodiazepines are often provided as primary sedation therapy. Protocoled management with scheduled, objective assessments helps minimize morbidity and mortality. Daily sedation interruptions, when appropriate, have been shown to decrease duration of mechanical ventilation. Complementary pharmacologic agents such as alpha-2 agonists (deximatomidine and clonidine), typical (Haldol), and atypical antipsychotics (risperdone, olanzapine, ziprasidone) can also be used, in appropriate patients, for the management of sedation and anxiety [62].
Pain, Agitation, and Delirium in the ICU
Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba in Acute Care Surgery and Trauma, 2016
The Richmond Agitation–Sedation Scale (RASS) and Sedation–Agitation Scale (SAS) (see Table 80.1) have yielded the highest psychometric scores and were found to be the most valid, reliable, and discriminatory sedation assessment tools for measuring quality and depth of sedation in adult ICU patients [8–10]. Moderate to high correlations were found between these scales and electroencephalogram (EEG) or bispectral index (BIS) values [11,12]. In head-to-head comparison, neither is demonstrably superior to the other.
Elevated sTREM2 and NFL levels in patients with sepsis associated encephalopathy
Published in International Journal of Neuroscience, 2023
Günseli Orhun, Figen Esen, Vuslat Yilmaz, Canan Ulusoy, Elif Şanlı, Elif Yıldırım, Hakan Gürvit, Perihan Ergin Özcan, Serra Sencer, Nerses Bebek, Erdem Tüzün
All participants underwent detailed neurological examination by neurologists and ICU specialists. Components of the neurologic assessment in the ICU included the level of consciousness and delirium assessment. Delirium was assessed twice daily by trained research nurses using the Confusion Assessment Method for the ICU (CAM-ICU) [22]. Patients were diagnosed with delirium when they had at least one positive CAM-ICU assessments. The sedation level was measured via the Richmond Agitation-Sedation Scale [23]. Daily interruption of sedation was performed for the level of consciousness and those patients with a Glasgow Coma Scale ≤ 8 were accepted as comatose. The presence of one of generalized or focal, tonic or clonic, short or long term and recurrent movement on the face or extremities was defined as an epileptic seizure. Any lateralized deficit was considered a focal neurological deficit.
Agitated behavior scale in pediatric traumatic brain injury
Published in Brain Injury, 2019
Magda Nowicki, Lisa Pearlman, Craig Campbell, Rhiannon Hicks, Douglas D. Fraser, Jamie Hutchison
To date, very few responsiveness scales for acute agitation have been tested in pediatric patients. The University of Michigan Sedation Scale measures only sedation, and is not useful in children who are agitated (22). Other tools such as the Richmond Agitation-Sedation Scale and the Pediatric Sedation-Agitation Scale are tools that span the full spectrum of responsiveness (from sedation to agitation). However, the broad spectrum of these scales’ measurements reduces the sensitivity of identifying agitation in its various forms. Furthermore, out of these two sedation-agitation scales, only the Richmond Agitation-Sedation Scale has been validated for use in critically ill children (19). The current results support the ABS as a valid scale in specifically measuring agitation in pediatric patients recovering from acute TBI.
Suboptimal palliative sedation in primary care: an exploration
Published in Acta Clinica Belgica, 2018
Peter Pype, Inge Teuwen, Fien Mertens, Marij Sercu, An De Sutter
A registration form was composed with relevant factors based on literature: patient’s age, diagnosis, comorbidity, refractory symptoms and concomitant medication use [17]. Were also registered: the starting dose of sedatives, the time span between the successive dose adjustments, the level of dose adjustments, time until death, the number of awakenings and the use of adjuvant sedatives. Finally, the Richmond agitation sedation scale was used to measure the depth of sedation throughout the procedure [18]. All PHCTs were handed over a manual with instructions on the registration procedures to obtain uniform registrations.
Related Knowledge Centers
- Psychomotor Agitation
- Sedation
- Scale
- Confusion Assessment Method