机械通气患者镇静评估工具的研究进展

对机械通气患者进行镇静评估有助于给予恰当的镇静治疗,以减少镇静药物的使用。检索相关文献,对各种评估工具的来源、条目、计分、适用范围、局限性及应用现状等进行阐述。评估工具联合使用既可避免主观因素的影响,同时也能实时连续地反映患者的镇静状态,为患者提供更合理的镇静治疗。     

护士镇静交流评分工具在ICU应用的效果研究

目的:探讨护士镇静交流评分工具(Nursing Instrument for the Communication of Sedation,NICS)在ICU应用的效果。方法:采用便利抽样方法,对50名ICU护士进行调查,评价其信效度。采用前瞻性队列研究方法,对46名ICU持续镇静患者进行评估,比较NICS与其他三种评估表的相关性。结果:护士镇静交流评分工具(NICS)Cronbach'sα系数为0.863,标准效度系数为0.915(P0.01),NICS与Ramsay、SAS、MAAS三种评估表在4个不同时间点均呈显著相关性,在评估患者躁动、镇静状态准确性、医务人员是否容易记忆及内容和分值相关度等方面,NICS在4个评估表中排名首位,差异具有统计学意义。结论:护士镇静交流评分工具(NICS)具有良好的信效度,其与Ramsay、SAS及MAAS评估表相关性良好,操作简单,受到护士的欢迎。     

冠心病病人心脏康复护理需求评估工具的研究进展

通过对国内外学者开发的冠心病病人心脏康复护理需求评估工具进行总结，概述心脏康复护理需求评估工具的应用情况、适用范围及局限性，并对各评估工具的基本情况及内容进行比较分析，旨在为临床护士选择合理的心脏康复评估工具，提高心脏康复护理质量提供参考依据。     

癌症病人家庭复原力评估工具的研究进展

介绍家庭复原力的起源及概念,对家庭复原力评估工具内容、特点、应用情况等进行综述,对现有评估工具进行比较并提出建议,为研究者开发符合我国文化背景的特异性癌症病人家庭复原力评估工具及临床护士选择合适的评估工具提供参考。     

脑电双频指数评估重症患者镇静深度的研究现状

相较于重症监护病房（ICU）治疗中对镇静药物的广泛应用,ICU医务人员多存在对药物知识以及镇静治疗效果长效评估工具的缺乏,使患者常处于镇静过度的状态,导致出现包括延迟脱机、机械通气相关性肺炎等一系列并发症。对于重症患者的镇静深度评估工具的开发应用目前多为主观评估工具,存在诸多缺陷。随着近年来一些客观评估工具,如脑电双频指数（bispectral index,BIS）的引人为医护人员提供了新的尝试。本文针对应用脑电双频指数评估重症患者镇静深度的研究近况综述如下。     

联合应用镇静评估工具对机械通气患者行镇静评估的研究

<正>ICU患者病情危重,往往需要借助多种侵入性治疗手段。这些治疗措施的实施可能会使患者产生不良经历,而合理的镇静治疗能够减少患者的不适经历,有计划地进行镇静评估是保证合理镇静的前提条件。保障机械通气患者能得到合适的镇静效果是镇静管理的关键。本研究联合使用护士镇静交流评分工具(NICS)和BIS两种镇静评估工具,并根据评估结果进行镇静药物的精确     

化疗致周围神经病变病人报告结局评估工具研究进展

对化疗致周围神经病变病人报告结局评估工具进行综述,分别从普适性、特异性病人报告结局评估工具的特点、在临床中的应用情况进行阐述,分析现有评估工具存在的问题并提出建议,以期为我国化疗致周围神经病变病人报告结局评估工具的开发、应用及临床决策提供参考依据。     

危重症患儿疼痛状况评估及护理

目的 了解危重症患儿的疼痛水平及疼痛控制情况,为常规开展疼痛评估及护理工作提供临床依据。方法 通过运用FLACC量表对不同疾病类型的危重症患儿进行疼痛评估,了解危重症患儿的疼痛状况及疼痛治疗效果。结果 27例危重症患儿中共进行疼痛评估286次,其中评分〉3分的66次,占23.1%;持续芬太尼镇静镇痛患儿的疼痛率为9.6%。16例机械通气患儿疼痛率为30.6%。结论 疼痛是儿童危重症护理中的常见问题,需要常规进行疼痛评估,合适的评估工具及准确的评估,是进行疼痛治疗的前提条件,非药物的疼痛护理方法 应成为疼痛护理的常规。     

躁动镇静评分在重症患者中应用的研究进展

Richmond躁动-镇静评分（Richmond Agitation and Sedation Scale,RASS）是目前国内外多项指南推荐的镇静效果评价工具,RASS在重症患者镇静效果评价中具有明显的优势,在适宜的RASS评估频次和目标值指导下,可应用于机械通气、躁动、谵妄及其他重症患者,通过实施个体化、针对性的镇静护理评估方案,可缩短机械通气时间,降低病死率,减少不良事件的发生。因此该文对使用RASS进行镇静效果评价的研究进展进行综述,以进一步推广RASS的标准应用,促进重症患者镇静护理质量的改善。     

急性白血病患者报告结局研究进展

对国内外开发的急性白血病患者报告结局评估工具及其临床应用情况进行综述，旨在为急性白血病患者报告结局评估工具的应用、开发及临床实践提供借鉴和参考。     

Advancing sedation assessment to promote patient comfort

As sedation assessment continues to evolve towards a more disciplined and standard part of clinical practice, the use of subjective sedation scales and objective sedation tools such as the BIS monitor continues to grow and show promise. The efforts of critical care nurses and their colleagues to better understand the value of these tools is integral to guiding their use and optimizing patient comfort.     

Sedation assessment in critically ill adults.

OBJECTIVE: To review methods for assessing sedation in critically ill adults, discuss their impact on patient outcomes, and provide recommendations for implementing these methods into clinical practice in the intensive care unit (ICU). DATA SOURCES: A computerized search of MEDLINE from 1980 through June 2000 and a manual search of abstracts presented at recent critical care meetings were performed. STUDY SELECTION AND DATA EXTRACTION: Sedation assessment tools that have been used to titrate therapy in adult, critically ill patients were identified. Special emphasis was placed on sedation assessment instruments that have been prospectively validated. Objective methods that have been used to assess sedation therapy were also identified. DATA SYNTHESIS: Twenty-three adult sedation assessment instruments were identified. Few scales have been prospectively evaluated for validity (n = 6) or reliability (n = 7). Other methods of sedation assessment were identified (e.g., bispectral index monitor); however, most of these methods have only been studied in small subsets of critically ill patients. CONCLUSIONS: Incorporation of sedation assessment into ICU clinical practice may improve patient care. These sedation assessment instruments must be further evaluated to determine their impact on quality of care and ICU length of stay.     

Sedation assessment in critically ill adults: 2001-2004 update

OBJECTIVE: To review recently published literature on the validity and reliability of sedation assessment tools in critically ill adults and evaluate the potential advantages and disadvantages of each. DATA SOURCES: A computerized search of MEDLINE and PubMed (2001-May 2004) was conducted. STUDY SELECTION AND DATA EXTRACTION: Sedation assessment tools used in adult intensive care units (ICUs) were identified. DATA SYNTHESIS: Six subjective and 3 objective assessment tools were identified. Four subjective assessment tools have reliability and 4 have validity data published that were not previously available. There are reliability data to further support the use of the previously published Motor Activity Assessment Scale. Additional reliability data exist for the Ramsay Scale and Glasgow Coma Scale. Conflicting evidence is available with the use of the Bispectral Index monitor in the ICU. Recently, the Patient State Index and Auditory Evoked Potentials were introduced for objective monitoring in critically ill patients. CONCLUSIONS: Increasing data on sedation assessment were published over the last few years, probably in response to supporting evidence that goal-driven sedation therapy improves patient outcomes. Reliability and/or validity testing exists for many of these scales. Several useful tools are available to guide sedation therapy in critically ill patients.     

The sedation of critically ill adults: Part 1: Assessment. The first in a two-part series focuses on assessing sedated patients in the ICU

The prevention or treatment of pain, anxiety, and delirium in the ICU is an important goal. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ventilation, can be challenging. Both under- and oversedation carry serious risks. In 2002 the Society of Critical Care Medicine, along with the American Society of Health-System Pharmacists, updated recommendations in its clinical practice guidelines for the sustained use of sedatives and analgesics in adults. This two-part series examines those recommendations that relate to sedation assessment and management, as well as the current literature. This month Part 1 also reviews pertinent recommendations concerning pain and delirium and discusses tools for assessing pain, delirium, and sedation. In August Part 2 will explore pharmacologic and nonpharmacologic management of anxiety and agitation in critically ill patients. The prevention or treatment of pain, anxiety, and delirium in the ICU is an important goal. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ventilation, can be challenging. Both under- and oversedation carry serious risks. In 2002 the Society of Critical Care Medicine, along with the American Society of Health-System Pharmacists, updated recommendations in its clinical practice guidelines for the sustained use of sedatives and analgesics in adults. This two-part series examines those recommendations that relate to sedation assessment and management, as well as the current literature. This month Part 1 also reviews pertinent recommendations concerning pain and delirium and discusses tools for assessing pain, delirium, and sedation. In August Part 2 will explore pharmacologic and nonpharmacologic management of anxiety and agitation in critically ill patients.     

Sedation scoring in a general ICU--comparative trial of two assessment tools in clinical practice

The literature surrounding sedation and assessment tools is reviewed Action research is used to assess the transferability of two published assessment tools Recommendations for improving this aspect of patient care are given Areas for future research are highlighted     

ICU患者疼痛评估工具研究进展

疼痛是ICU患者的常见问题,有效的评估是疼痛管理的基础。由于镇静或其他原因,ICU患者的疼痛评估往往比较复杂。能获得患者主诉时可以使用主观疼痛评估工具,不能获得患者主诉时宜使用客观疼痛评估工具。本文就ICU患者常用的主观和客观疼痛评估工具进行综述,为完善ICU患者的疼痛评估和疼痛管理流程提供科学的依据。     

Clinical Aspects of Palliative Sedation in Prospective Studies. A Systematic Review

ContextNear the end of life when patients experience refractory symptoms, palliative sedation may be considered as a last treatment. Clinical guidelines have been developed, but they are mainly based on expert opinion or retrospective chart reviews. Therefore, evidence for the clinical aspects of palliative sedation is needed.ObjectivesTo explore clinical aspects of palliative sedation in recent prospective studies.MethodsSystematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered at PROSPERO. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019), combining sedation, palliative care, and prospective. Article quality was assessed.ResultsTen prospective articles were included, involving predominantly patients with cancer. Most frequently reported refractory symptoms were delirium (41%–83%), pain (25%–65%), and dyspnea (16%–59%). In some articles, psychological and existential distress were mentioned (16%–59%). Only a few articles specified the tools used to assess symptoms. Level of sedation assessment tools were the Richmond Agitation Sedation Scale, Ramsay Sedation Scale, Glasgow Coma Scale, and Bispectral Index monitoring. The palliative sedation practice shows an underlying need for proportionality in relation to symptom intensity. Midazolam was the main sedative used. Other reported medications were phenobarbital, promethazine, and anesthetic medication—propofol. The only study that reported level of patient's discomfort as a palliative sedation outcome showed a decrease in patient discomfort.ConclusionAssessment of refractory symptoms should include physical evaluation with standardized tools applied and interviews for psychological and existential evaluation by expert clinicians working in teams. Future research needs to evaluate the effectiveness of palliative sedation for refractory symptom relief.     

Monitoring sedation, agitation, analgesia, and delirium in critically ill adult patients.

The recent development of valid and reliable assessment tools to monitor agitation, sedation, analgesia, and delirium in the ICU represents an essential first step in the provision of patient comfort and the development of preferred treatment strategies. To make the ICU a more humane healing environment, these assessment tools must be used as part of a comprehensive evaluation of interventional and preventive treatments, pharmacologic and nonpharmacologic. In the spirit of the JCAHO, it may be time to add the evaluation of sedation, agitation, and delirium to that of pain assessment, making all aspects of patient comfort the fifth vital sign for the critically ill.     

Evaluating and monitoring analgesia and sedation in the intensive care unit

Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value.     

Uncertain terms of sedation in ICU. How nurses and physicians manage and describe sedation for mechanically ventilated patients

? Sedation which is used for intubated patients may prolong mechanical ventilation by increasing the risk of complications. The aim of the study was to illuminate the specific terminology and unrecognized contextual factors which may influence nurses' and physicians' sedation practices. ? The main research questions were: How do nurses and physicians describe sedation? and How does the level of nursing skill relate to the level of sedation? The hypotheses were that sedation practices are inconsistent and that experienced nurses provide a better quality of sedation than less experienced nurses. The hypotheses were supported by the study. ? The research strategy was case study research with triangulation of sources and methods and a multicentre multiple‐case design. Four university hospitals in Copenhagen, Denmark, and 14 cases were included in the study. The findings were based on secondary analysis of observation, interviews and chart review. ? The theoretical framework for the study was the problem‐solving model, in which sedation was assumed to be provided according to indication (clinical problem), intervention (clinical decision) and expected outcome (clinical end‐point). Indications could be patient‐related, ventilator‐related, or patient–ventilator related. Interventions could be related to the choice of agent, dose or administration method and the outcome was the level of sedation. ? Sedative therapy was prescribed by physicians and administered by nurses. The four sites in the study did not use guidelines for sedation and did not use sedation level assessment tools. The study shows that when the terminology is unclear, the indications, interventions and outcomes become unclear.