The Brussels sedation scale: use of a simple clinical sedation scale can avoid excessive sedation in patients undergoing mechanical ventilation in the intensive care unit

Sedation is an important component of patient comfort in the intensive care unit (ICU), especially in those undergoing mechanical ventilation. Sedatio n that is too light or too deep can have important consequences, and theref ore assessment of the degree of sedation should be an important part of pat ient management. Although there are many methods available to assess the de gree of sedation, none is ideal. Therefore, we developed a new sedation sca le and analysed its clinical impact in the management of patients undergoin g mechanical ventilation. The study comprised two consecutive phases. In th e first phase, the medical team did not use a sedation scale. In the second phase, the medical staff used the new sedation scale, comprising five leve ls, depending on the perceived degree of sedation: levels I and 2=oversedat ion; levels 3 and 4=correct sedation; and level 5=undersedation. There were no significant differences in mean or highest levels between patients in t he Mo phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P=0.22; highest 3.16 (0.1 1) vs 3.10 (0.14), P=0.78). However, the lowest level was significantly gre ater in patients in the second phase than in those in the first phase (2.6 1 (0.11) vs 2.16 (0.13); P=1.011), indicating that the number of patients w ith excessive sedation was significantly reduced with the introduction of t his scale. Thus the use of this scale can have a real clinical impact for p atients undergoing mechanical ventilation, principally by avoiding excessiv e sedation.