Evaluation of different sedation scales in the ICU management of COVID-19 patients.

This study evaluated the inter-rater reliability and diagnostic validity of different sedation scales for COVID-19 patients in the ICU, focusing on optimizing patient management and outcomes amidst unique pathophysiological challenges. Seventy-three mechanically ventilated COVID-19 patients sedated with intravenous ketamine (10-20 µg/kg/min) were evaluated at Ali Ibn Abi Talib Hospital, Zahedan, Iran, in 2022 and 2023. The sample size was calculated to detect significant differences with a 95% confidence level. Data collection included demographic information and four sedation scales: Riker Sedation-Agitation Scale, Motor Activity Assessment Scale, Richmond Agitation-Sedation Scale, and Ramsay Sedation Scale. The primary outcome measure was inter-rater reliability, quantified by Cohen's Kappa coefficients. Diagnostic validity (criterion validity) was examined by comparing scale scores across demographic and clinical variables. Statistical analyses included the Friedman test, Kappa statistics, and independent T-tests. The study involved patients with a mean age of 56.5 ± 14.1 years, ranging from 37 to 66 years, with 67.1% being male (n = 49) and 32.9% female (n = 24). The Friedman test showed no significant differences in sedation scores among raters or scales (p-values: Riker Sedation-Agitation Scale = 0.89, Motor Activity Assessment Scale = 0.67, Richmond Agitation-Sedation Scale = 0.76, Ramsay Sedation Scale = 0.81). Inter-rater reliability was high across all scales, with Kappa coefficients ranging from 0.71 to 0.89. Criterion validity analysis indicated no significant differences in sedation scores based on age, gender, ICU stay duration, or presence of comorbidities (all p > 0.05). These findings indicate that current sedation scales offer consistent evaluations for ICU COVID-19 patients, unaffected by rater bias or background factors. This reliability in clinical settings suggests their effective use for consistent patient assessments, potentially enhancing outcomes.