Tasaka Chelsea L, Duby Jeremiah J, Pandya Komal, Wilson Machelle D, A Hardin Kimberly
Department of Pharmacy, University of California San Francisco Medical Center , 505 Parnassus Avenue, San Francisco, CA 94143 USA ; University of California, San Francisco, School of Pharmacy, San Francisco, CA USA.
University of California, Davis Medical Center, Sacramento, CA USA ; University of California, San Francisco, School of Pharmacy, San Francisco, CA USA ; Touro University, College of Pharmacy, Vallejo, CA USA.
Drugs Real World Outcomes. 2016 May 28;3(2):201-208. doi: 10.1007/s40801-016-0076-3. eCollection 2016 Jun.
Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS™) provides an objective measure of sedation; however, the role of BIS™ is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA).
The aim of this study was to delineate the relationship between BIS™ and level of sedation for critically ill patients during therapeutic paralysis.
This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BIS™ monitoring. The primary endpoint was the correlation of BIS™ <60 during therapeutic paralysis with a Richmond Agitation Sedation Score (RASS) of -4 to -5 (i.e., deep or unarousable sedation) at the time of emergence from therapeutic paralysis.
Thirty-one patients were included in the analysis. Three of these patients (9.6 %) were inadequately sedated upon emergence from paralysis; that is, restless or agitated (RASS +1 to +2). We did not observe a correlation between BIS™ and RASS upon emergence from paralysis ( = 0.27, = 0.14). The sensitivity of BIS™ <60 in predicting deep sedation (RASS -5 to -4) was 100 % (95 % confidence interval [CI] 0-100) with a positive predictive value of 35.7 %. The sensitivity and positive predictive value of BIS™ <60 in predicting light sedation or deeper (RASS -5 to -2) was 92.9 % (95 %CI 83.3-100) and 92.9 %, respectively.
These results suggest that 1 in 10 critically ill patients receiving therapeutic paralysis may be inadequately sedated. BIS™ monitoring may serve as a useful adjunctive measure of sedation in critically ill patients receiving therapeutic paralysis.
由于行为镇静评估存在内在局限性，接受治疗性麻痹的患者可能会出现镇静不足的情况。脑电双频指数（BIS™）可提供客观的镇静测量；然而，在接受神经肌肉阻滞剂（NMBA）治疗的重症监护病房（ICU）患者中，BIS™的作用尚未明确界定。
本研究旨在明确治疗性麻痹期间危重症患者的BIS™与镇静水平之间的关系。
这是一项对接受持续输注NMBA并进行BIS™监测的ICU患者进行的回顾性观察研究。主要终点是治疗性麻痹期间BIS™<60与治疗性麻痹结束时里士满躁动镇静评分（RASS）为-4至-5（即深度或无法唤醒的镇静）之间的相关性。
31例患者纳入分析。其中3例患者（9.6%）在麻痹结束时镇静不足，即烦躁或激动（RASS为+1至+2）。我们未观察到麻痹结束时BIS™与RASS之间存在相关性（r = 0.27，P = 0.14）。BIS™<60预测深度镇静（RASS为-5至-4）的敏感性为100%（95%置信区间[CI]为0-100），阳性预测值为35.7%。BIS™<60预测轻度镇静或更深程度镇静（RASS为-5至-2）的敏感性和阳性预测值分别为92.9%（95%CI为83.3-100）和92.9%。
这些结果表明，每10名接受治疗性麻痹的危重症患者中可能有1例镇静不足。BIS™监测可作为接受治疗性麻痹的危重症患者镇静的有用辅助措施。
