Turkmen A, Altan A, Turgut N, Vatansever S, Gokkaya S
Okmeydani Education and Research Hospital, Department of Anaesthesiology and Reanimation, Istanbul, Turkey.
Eur J Anaesthesiol. 2006 Apr;23(4):300-4. doi: 10.1017/S0265021506000081. Epub 2006 Jan 27.
The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients.
This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17-82 (50.09 +/- 17.76; mean +/- SD) yr, 3 males and 8 females, APACHE II score 12.63 +/- 3.90, SOFA score 3.27 +/- 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 microg kg-1 over 10 min followed by a maintenance infusion of 0.5 microg kg-1 h-1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis.
The variation of Richmond agitation sedation scale score was between 0.9 and -1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001)
Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.
危重症患者镇静的主要目标是实现安全与舒适。需要常规使用标准化且经过验证的镇静评分量表和监测仪。里士满躁动镇静量表已被使用，但一些患者无法使用诸如里士满躁动镇静量表等主观评估工具进行评估，因为他们因治疗性麻痹而缺乏运动反应能力，或者因为他们正在接受深度镇静。我们旨在评估右美托咪定镇静期间脑电双频指数与里士满躁动镇静量表的相关性，并评估脑电双频指数在监测重症监护患者镇静水平中的应用。
这是一项单中心、前瞻性临床研究。纳入了11例机械通气的危重症患者，年龄17 - 82（50.09±17.76；均值±标准差）岁，男性3例，女性8例，急性生理与慢性健康状况评分系统II（APACHE II）评分为12.63±3.90，序贯器官衰竭评估（SOFA）评分为3.27±1.73。患者在10分钟内接受1μg/kg的右美托咪定静脉输注，随后以0.5μg/kg·h - 1的维持输注量持续8小时。使用里士满躁动镇静量表和脑电双频指数监测进行镇静评估。监测心率、血压、呼吸频率和血氧饱和度。采用Wilcoxon符号秩和检验和Spearman秩相关分析进行统计分析。
里士满躁动镇静量表评分的变化范围为0.9至 - 1.7，脑电双频指数在65至75之间变化。本研究发现里士满躁动镇静量表与脑电双频指数值之间存在显著相关性。（r = 0.900；P = 0.0001）
在重症监护病房需要机械通气的危重症患者中，右美托咪定镇静期间里士满躁动镇静量表水平与脑电双频指数值显著相关。
