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Clinical Sedation Score of Hartwig et al for Children in the Pediatric Intensive Care Unit

Purpose: To monitor a child in the pediatric intensive care unit (ICU) for sedation using the clinical score of Hartwig et al.

Description

Hartwig et al developed a clinical score for monitoring sedation of a child in the pediatric intensive care unit (PICU). This can be used for adjusting the dose of sedative to maintain the desired level of sedation. The authors are from the University of Cologne in Germany.


Parameters:

(1) motor response

(2) mimic

(3) eyes

(4) respiration

(5) aspiration (suctioning)

 

Assessment is conducted every 3 hours by the nursing staff.

 

Parameter

Finding

Points

motor response

no spontaneous movements

1

 

spontaneous movements with pain

2

 

spontaneous movements of extremities

3

 

spontaneous global movements

4

 

continuous spontaneous movements, restless

5

mimic

no reaction

1

 

grimacing only with pain

2

 

cries only when with pain, rapid return to rest

3

 

cries even when without pain, but soon returns to rest

4

 

cries, difficult to soothe (console)

5

eyes

permanently closed

1

 

opening only with pain

2

 

opening when manipulated, quickly falls asleep again

3

 

spontaneous opening, soon returns to sleep

4

 

spontaneous opening, awake for long periods, sweating

5

respiration

easy spontaneous breathing, fully synchronized

3

 

mechanical respiration not disturbed by spontaneous breathing

4

 

spontaneous breathing not synchronous with machine, tachypnea

5

response to aspiration (suctioning)

no reaction when aspirated

2

 

grimacing only, no movements of extremities

3

 

little coughing or retching

4

 

strong opposition, intense coughing, straining

5

 

clinical score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 8

• maximum score: 25

 

Score

Sedation

8

deepest sedation

15 – 18

target level

25

insufficient sedation

 

Limitations:

• As with any score, it assumes that all of the responses move in tandem and that masking does not occur.


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Specialty

Objective

ICD-10