Walsh Timothy S, Everingham Kirsty, Frame Fiona, Lapinlampi T Petteri, Särkelä Mika O K, Uutela Kimmo, Viertiö-Oja Hanna E
Centre for Inflammation Research, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
Centre for Inflammation Research, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland.
J Crit Care. 2014 Oct;29(5):886.e1-7. doi: 10.1016/j.jcrc.2014.05.008. Epub 2014 May 28.
The purpose of this study is to explore the validity of a novel sedation monitoring technology based on facial electromyelography (EMG) in sedated critically ill patients.
The Responsiveness Index (RI) integrates the preceding 60 minutes of facial EMG data. An existing data set was used to derive traffic light cut-offs for low (red), intermediate (amber), and higher (green) states of patient arousal. The validity of these was prospectively evaluated in 30 sedated critically ill patients against hourly Richmond Agitation Sedation Scale (RASS) assessments with concealment of RI data from clinical staff.
With derivation data, an RI less than or equal to 35 had best discrimination for a Ramsay score of 5/6 (sensitivity, 90%; specificity, 79%). For traffic lights, we chose RI less than or equal to 20 as red, 20 to 40 as amber, and more than 40 as green. In the prospective study, RI values were red/amber for 76% of RASS -5/-4 assessments, but RI varied dynamically over time in many patients, and discordance with RASS may have resulted from the use of 1 hour of data for RI calculations. We also noted that red/amber values resulted from sleep, encephalopathy, and low levels of stimulation.
Responsiveness Index is not directly comparable with clinical sedation scores but is a potential continuous alert to possible deep sedation in critically ill patients.
本研究旨在探讨一种基于面部肌电图（EMG）的新型镇静监测技术在危重症镇静患者中的有效性。
反应指数（RI）整合了前60分钟的面部EMG数据。利用现有的数据集得出患者觉醒低（红色）、中（琥珀色）、高（绿色）状态的交通信号灯截断值。对30例危重症镇静患者进行前瞻性评估，将这些截断值与每小时的里士满躁动镇静量表（RASS）评估进行对比，且不向临床工作人员透露RI数据。
根据推导数据，RI小于或等于35对拉姆齐评分5/6的辨别能力最佳（敏感性为90%；特异性为79%）。对于交通信号灯标准，我们选择RI小于或等于20为红色，20至40为琥珀色，大于40为绿色。在前瞻性研究中，76%的RASS -5/-4评估的RI值为红色/琥珀色，但许多患者的RI值随时间动态变化，RI与RASS不一致可能是由于RI计算使用了1小时的数据。我们还注意到，红色/琥珀色值是由睡眠、脑病和低水平刺激导致的。
反应指数与临床镇静评分不能直接比较，但可能是对危重症患者可能出现深度镇静的一种持续警示。
