Page 476 - Clinical Application of Mechanical Ventilation

442 Chapter 13

TABLE 13-13 Ramsay Scale for Assessment of Sedation

Level/Score Clinical Description

I Anxious and agitated

II Cooperative, oriented, tranquil
III Responds only to verbal commands

IV Asleep with brisk response to light stimulation
V Asleep with sluggish response to stimulation

VI Asleep without response to stimulation
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mechanical ventilation. If a short period of sedation is needed, intermittent intra-
venous bolus dosing may prevent oversedation. If prolonged periods of sedation are
required, a bolus followed by a continuous infusion may provide optimal patient
comfort. If the indication is to facilitate an uncomfortable procedure, an intrave-
nous bolus dose should be given.
Since individual patient response to benzodiazepines is highly variable, monitor-
Ramsay Scale: The scoring
system with a scale ranging from ing is essential to ensure correct dosing and reduce costs. Assessment of a patient’s
level I to level VI; used to assess sedation state may be done with the Ramsay Scale for Assessment of Sedation as
the degree of sedation.
outlined in Table 13-13 (Ramsay et al., 1974). Using the Ramsay Scale and the
appropriate types and dosages of benzodiazepines (Table 13-14), a desired level of
sedation may be determined.
Ramsay Scale is not
suitable for paralyzed patients It is important to note that the Ramsay Scale is not suitable for paralyzed patients.
since they cannot perform Since they cannot perform those required commands for the Ramsay Scale, autonomic
those required commands.
signs such as tachycardia, diaphoresis, hypertension, and lacrimation may suggest inad-
equate sedation or pain control (Shelly et al., 1986).

Autonomic signs (tachy- Opioid Analgesics
cardia, diaphoresis, hyperten-
sion, and lacrimation) may
suggest inadequate sedation
or pain control. Patients on mechanical ventilation may have a variety of medical or surgical problems
that necessitate attention to pain control. In these patients, however, pain is difficult

TABLE 13-14 Common Benzodiazepines Used in Mechanical Ventilation

Drug Initial Dose Onset Duration

Diazepam (Valium) 2.5 to 10 mg IV Fast Short initially; multiple doses result
in prolonged effect

Lorazepam (Ativan) 0.5 to 2 mg IV Intermediate Intermediate
Midazolam (Versed) 1 to 5 mg IV Fast Short, but may be prolonged if not
carefully dosed
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