Miner James R, Fringer Ryan, Siegel Todd, Gaetz Andrea, Ling Louis, Biros Michelle
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Am J Emerg Med. 2006 Jan;24(1):53-7. doi: 10.1016/j.ajem.2005.07.006.
Many patients who overdose on sedatives experience a declining mental status and eventually require endotracheal intubation. The goal of this study was to determine if serial bedside Bispectral index (BIS) scores monitoring can be used to detect the eventual need for intubation in overdosed patients who are undergoing observation in the ED.
This was a prospective, observational study of a convenience sample of patients who presented to the Hennepin County Medical Center ED between June and November 2002. Patients being treated and observed for a suspected sedative ingestion were eligible. Upon presentation, a Bispectral electroencephalographic probe was applied to the patient's forehead, and a BIS score was recorded at 0 and 20 minutes. The Altered Mental Status scale was used to describe the patient's clinical status. Data were collected by trained research assistants. Data are described with descriptive statistics. The mean changes in BIS score between patients who did and did not require intubation are compared with t tests, and the outcome of patients with stable vs declining BIS scores were compared with chi(2) tests.
Seventy-six patients were enrolled. The mean initial BIS score was 83.9 (95% CI, 79.7-88.1; range, 9-99). The mean change in BIS scores during the 20-minute observation period for the patients who required intubation was -13.5 (95% CI, -30.2 to 3.2) and was +6.7 (95% CI, 3.3-10.1) for those who were not intubated. Sixteen patients had an initial BIS score below 70. Of these patients, 6 were intubated. All intubations occurred during the 20 minutes, and this group had a mean initial BIS of 47.2 (95% CI, 35.6-58.8). The 10 patients with an initial BIS below 70 who were not intubated had a mean increase in BIS score of 23.3 (95% CI, 11.7-33.9) during the 20 minutes. Of the 60 patients whose first BIS score was above 70, 5 were eventually intubated during their ED treatment. The mean change in BIS was -36.4 (95% CI, -18.7 to -54.1) for the intubated patients vs +7.9 (95% CI, 4.4-11.3) for nonintubated patients during the first 20 minutes.
The overdosed patients who required intubation during their ED treatment experienced a mean decrease in BIS during the first 20 minutes, compared with those who did not. Bispectral index scores monitoring may prove useful for earlier ED treatment and decision making regarding sedative overdose patients.
许多过量服用镇静剂的患者会出现精神状态下降，最终需要进行气管插管。本研究的目的是确定连续床旁脑电双频指数（BIS）评分监测是否可用于检测在急诊科接受观察的过量服药患者最终是否需要插管。
这是一项前瞻性观察性研究，对2002年6月至11月间到亨内平县医疗中心急诊科就诊的便利样本患者进行研究。因疑似镇静剂摄入而接受治疗和观察的患者符合条件。就诊时，将脑电双频指数脑电图探头置于患者前额，在0分钟和20分钟时记录BIS评分。使用精神状态改变量表描述患者的临床状态。数据由经过培训的研究助理收集。数据用描述性统计进行描述。对需要插管和不需要插管的患者之间BIS评分的平均变化进行t检验比较，对BIS评分稳定与下降的患者的结果进行卡方检验比较。
共纳入76例患者。初始BIS评分的平均值为83.9（95%可信区间，79.7 - 88.1；范围，9 - 99）。在20分钟观察期内，需要插管的患者BIS评分的平均变化为 - 13.5（95%可信区间， - 30.2至3.2），未插管患者为 + 6.7（95%可信区间，3.3 - 10.1）。16例患者初始BIS评分低于70。其中6例患者进行了插管。所有插管均在20分钟内进行，该组患者的初始BIS平均为47.2（95%可信区间，35.6 - 58.8）。10例初始BIS低于70但未插管的患者在20分钟内BIS评分平均增加23.3（95%可信区间，11.7 - 33.9）。在首次BIS评分高于70的60例患者中，有5例在急诊科治疗期间最终进行了插管。在最初20分钟内，插管患者的BIS平均变化为 - 36.4（95%可信区间， - 18.7至 - 54.1），未插管患者为 + 7.9（95%可信区间，4.4 - 11.3）。
与未插管的患者相比，在急诊科治疗期间需要插管的过量服药患者在最初20分钟内BIS平均下降。脑电双频指数评分监测可能对镇静剂过量患者的早期急诊科治疗和决策有用。
