Department of Anaesthesiology and Critical Care, Beaujon University Hospital, Clichy, France.
Intensive Care Med. 2009 Dec;35(12):2096-104. doi: 10.1007/s00134-009-1636-8. Epub 2009 Sep 15.
Despite an overall correlation between the bispectral index of the EEG (BIS) and clinical sedation assessment, unexpectedly high BIS values can be observed at deep sedation levels. We assessed the frequency, interindividual variability and clinical impact of high BIS values during clinically deep sedation.
Prospective observational study in two university-affiliated intensive care units.
Sixty-two mechanically ventilated patients requiring intravenous sedation and analgesia for >or=24 h.
Paired measurements of BIS and sedation measured on the adaptation to intensive care environment (ATICE) score were obtained every 3 h until awakening. A paired measurement with BIS >60 at deep sedation (ATICE Awakeness <or=2) was defined as discordant. Patients were considered discordant if their individual ratio of number of discordant measurements to number of total measurements during deep sedation was above the median discordance ratio of the overall cohort. At least one discordant assessment was observed in 52 patients (83.9%). Median individual discordance ratio was 32% (14.3-50.0%). Time from awakening to first T-piece trial [16 h (4-34) vs. 46 h (9-109), p = 0.01] and to extubation [35 h (23-89) vs. 88 h (46-152 h), p = 0.05] were significantly shorter in discordant compared to concordant patients. BIS-ATICE discordance was independently associated with successful extubation within 48 h after awakening (OR 6.7, CI 95% 1.8-25.0, p = 0.005). The rate of ICU recall was not different in BIS-ATICE discordant and concordant patients.
In mechanically ventilated ICU patients, discordance between high BIS values and deep clinical sedation is frequently observed and may suggest faster weaning from the ventilator.
尽管脑电图双频指数（BIS）与临床镇静评估之间存在总体相关性，但在深度镇静水平下，可能会观察到出乎意料高的 BIS 值。我们评估了在临床深度镇静期间高 BIS 值的频率、个体间变异性和临床影响。
在两所大学附属医院的重症监护病房进行的前瞻性观察性研究。
62 名需要静脉镇静和镇痛超过 24 小时的机械通气患者。
每 3 小时获得一次 BIS 和镇静测量的适应重症监护环境（ATICE）评分的配对测量，直到觉醒。在深度镇静（ATICE 清醒度 <or=2）时，将 BIS >60 的配对测量定义为不匹配。如果患者在深度镇静期间个体不匹配测量数与总测量数的比值高于总体队列的中位数不匹配比值，则认为患者不匹配。52 名患者（83.9%）中观察到至少一次不匹配评估。中位数个体不匹配比为 32%（14.3-50.0%）。从觉醒到第一次 T 型管试验的时间[16 小时（4-34）比 46 小时（9-109），p = 0.01]和到拔管的时间[35 小时（23-89）比 88 小时（46-152 小时），p = 0.05]在不匹配患者中明显短于匹配患者。BIS-ATICE 不匹配与觉醒后 48 小时内成功拔管独立相关（OR 6.7，CI 95% 1.8-25.0，p = 0.005）。BIS-ATICE 不匹配和匹配患者的 ICU 召回率无差异。
在机械通气的 ICU 患者中，高 BIS 值与深度临床镇静之间的不匹配经常观察到，这可能提示更快地从呼吸机中脱机。
