Correlation of patient-reported outcomes of sedation and sedation assessment scores in critically ill patients

Abstract

Purpose: Patient-reported outcomes (PROs) are recommended as indicators of quality in the intensive care unit. We studied the correlation between PROs of sedation quality and a universal sedation assessment scale in critically ill patients.

Materials and methods: Twenty-nine mechanically ventilated adults admitted to a surgical/trauma or medical intensive care unit requiring continuous infusion sedation for 24 hours or more were prospectively included. Patient-reported outcomes were evaluated through sedation questionnaire 24 hours post-continuous infusion sedation. The primary outcome was the correlation of PROs with Sedation-Agitation Scale (SAS) scores.

Results: Mean (SD) SAS scores per 12-hour nursing shift for propofol (n=179), midazolam (n=42), and dexmedetomidine (n=8) were 3.78 (77), 3.31 (1.1), and 2.98 (0.76), respectively. The mean score for survey questions addressing perceptions of comfort was 5.3 (1, complete comfort; 10, not comfortable at all). Of the patients, 34%, 7%, and 52% would want more, less, or the same amount of sedation, respectively, if this situation were to arise again. Patient perception of comfort correlated with the percent time at goal SAS score; r=0.31 (P<.05).

Conclusion: Patient-reported outcomes of sedation correlate with the percentage of time spent in the goal range of scores for a universal sedation assessment scale. These findings represent initial attempts to appreciate the patient's perspective in the management and monitoring of agitation.

Keywords: Dexmedetomidine; Midazolam; Patient reported outcomes; Propofol; Questionnaire; Sedation assessment.