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. Sedation that is too light or too deep can have important consequences, and therefore assessment of the degree of sedation should be an important part of patient management. Although there are many methods available to assess the degree of sedation, none is ideal. Therefore, we developed a new sedation scale and analysed its clinical impact in the management of patients undergoing mechanical ventilation. The study comprised two consecutive phases. In the 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 levels, depending on the perceived degree of sedation: levels I and 2=oversedation; levels 3 and 4=correct sedation; and level 5=undersedation. There were no significant differences in mean or highest levels between patients in the Mo phases (mean 2.89 (SD 0.11) vs 2.67 (0.13), P=0.22; highest 3.16 (0.11) vs 3.10 (0.14), P=0.78). However, the lowest level was significantly greater 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 with excessive sedation was significantly reduced with the introduction of this scale. Thus the use of this scale can have a real clinical impact for patients undergoing mechanical ventilation, principally by avoiding excessive sedation.