In this study, the signs the nurses considered most
important either generally or when assessing undersedation
corresponded best to the sedation and singlesymptom
scales. The nurses tended to assess more
signs of oversedation than most of the assessment
tools examined. They used the cough reflex to assess
the risk of oversedation, and ATICE includes the sign
‘no cough’ (De Jonghe et al., 2003). We interpret this to
mean that inATICE, ‘no cough’ is associated with a tolerance
of mechanical ventilation and is not intended as
an indicator of the depth of sedation. Some nurses also
perceived the corneal reflex as important, and testing
such reflexes may be an appropriate and gentle way of
estimating sedation depth (Mourisse et al., 2004; Deletis
et al., 2009), although it is not included in any assessment
tool. To assess the risk of oversedation, many
nurses used muscle tone and MAP, and the Comfort
Scale includes both these signs. One of the challenges