Using and understanding sedation scoring systems: a systematic review

Objective: To systematically review instruments for measuring the level and effectiveness of sedation in adult and pediatric ICU patients. Study indentification: We searched MEDLINE, EMBASE, the Cochrane Library an d reference lists of the relevant articles. We selected studies if the seda tion instrument reported items related to consciousness and one or more add itional items related to the effectiveness or side effects of sedation. Data abstraction: We extracted data on the description of the instrument an d on their measurement properties (internal consistency, reliability, valid ity and responsiveness). Results: We identified 25 studies describing relevant sedation instruments. In addition to the level of consciousness, agitation and synchrony with th e ventilator were the most frequently assessed aspects of sedation. Among t he 25 instruments, one developed in pediatric ICU patients (the Comfort Sca le), and 3 developed in adult ICU patients (the Ramsay scale, the Sedation- Agitation-Scale and the Motor Activity Assessment Scale), were tested for b oth reliability and validity. None of these instruments were tested for the ir ability to detect change in sedation status over time (responsiveness). Conclusion: Many instruments have been used to measure sedation effectivene ss in ICU patients. However, few of them exhibit satisfactory clinimetric p roperties. To help clinicians assess sedation at the bedside, to aid reader s critically appraise the growing number of sedation studies in the ICU lit erature, and to inform the design of future investigations, additional info rmation about the measurement properties of sedation effectiveness instrume nts is needed.