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Excerpt
Introduction: Subjective sedation assessment in our surgical ICU (SICU) potentially hinders continuity of care, limits sedation protocol implementation and may lead to patient oversedation. The motor activity assessment scale (MAAS) has seven clearly described categories ranging from unresponsive to dangerously agitated. We sought to establish the validity and reliability of the MAAS in our SICU.
Methods: Four hundred assessments of 25 randomly selected, mechanically ventilated, non-neurosurgical patients admitted to the SICU who were >or=to 12 hours post surgery and not receiving neuromuscular blockers, were completed consecutively but independently, in pairs, at standardized times (both day and night) by two nurses preselected for each assessment from a pool of 32 pre-trained SICU nurses. Paired assessments (4 per patient) to estimate validity compared the MAAS result to subjective assessment using a 10cm visual analog sedation scale (VAS), the % change in blood pressure and heart rate from the previous 4 hour baseline, and the number of recent agitation-related sequelae. Paired assessments (4 per patient) to estimate reliability measured correlation between assessments of the same type (eg. MAAS-MAAS).
Results: Regression techniques supported MAAS validity by finding a linear trend between MAAS and the VAS, blood pressure, heart rate and agitation-related event endpoints (all p < 0.001). As data was gathered in clusters, a generalized estimating Equation methodologywas used to estimate regression coefficients. A descriptive analysis using Spearman's correlation coefficient (R) further supported MAAS validity [VAS (R = 0.9, p < 0.001), blood pressure (R = 0.26, p = 0.009), heart rate (R = 0.39, p = 0.0001) and agitation-related sequelae (R = 0.43, p = 0.0001)]. The MAAS [Kappa = 0.83 (95% CI, 0.72 to 0.94)] was found to be more reliable than subjective assessment using the VAS [Interclass correlation coefficient = 0.32 (95% CI, 0.05 to 0.55)].
Conclusions: The MAAS is a valid and reliable sedation scale for use in mechanically ventilated SICU patients. Further studies are warranted regarding the impact of MAAS implementation in our SICU on patient outcomes such as quality of sedation and length of mechanical ventilation as well as the use of MAAS in other patient populations (eg. medical).
