West Nicholas, McBeth Paul B, Brodie Sonia M, van Heusden Klaske, Sunderland Sarah, Dumont Guy A, Griesdale Donald E G, Ansermino J Mark, Görges Matthias
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
J Clin Monit Comput. 2018 Dec;32(6):1081-1091. doi: 10.1007/s10877-018-0115-6. Epub 2018 Feb 20.
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU. The aim of this observational study was to assess the feasibility of using the NeuroSENSE™ monitor for EEG-based continuous sedation assessment. With ethical approval, ICU patients on continuous propofol sedation were recruited. Depth-of-hypnosis index (WAV) values were obtained from the NeuroSENSE. Bedside nurses, blinded to the NeuroSENSE, performed regular RASS assessments and maintained the sedation regimen as per standard of care. Participants were monitored throughout the duration of their propofol infusion, up to 24 h. Fifteen patients, with median [interquartile range] age of 57 [52-62.5] years were each monitored for a duration of 9.0 [5.7-20.1] h. Valid WAV values were obtained for 89% [66-99] of monitoring time and were widely distributed within and between individuals, with 6% [1-31] spent < 40 (very deep), and 3% [1-15] spent > 90 (awake). Significant EEG suppression was detected in 3/15 (20%) participants. Observed RASS matched RASS goals in 36/89 (40%) assessments. The WAV variability, and incidence of EEG suppression, highlight the limitations of using RASS as a standalone sedation measure, and suggests potential benefit of adjunct continuous brain monitoring.
重症监护病房（ICU）中的镇静具有挑战性，因为镇静过度和不足都有害。当前的评估方法，如里士满躁动镇静量表（RASS），是间歇性测量的，且依赖于患者对刺激的行为反应，这可能会打断睡眠/休息。一种用于持续镇静监测的非刺激性方法可能有益，并能实现更频繁的评估。经过处理的脑电图（EEG）监测仪尚未在ICU中常规使用。这项观察性研究的目的是评估使用NeuroSENSE™监测仪进行基于脑电图的持续镇静评估的可行性。在获得伦理批准后，招募了接受丙泊酚持续镇静的ICU患者。从NeuroSENSE获得催眠深度指数（WAV）值。对NeuroSENSE不知情的床边护士进行常规RASS评估，并按照护理标准维持镇静方案。在丙泊酚输注期间（最长24小时）对参与者进行全程监测。15名患者，年龄中位数[四分位间距]为57[52 - 62.5]岁，每人监测时长为9.0[5.7 - 20.1]小时。在89%[66 - 99]的监测时间内获得了有效的WAV值，这些值在个体内部和个体之间分布广泛，6%[1 - 31]的时间处于<40（深度催眠），3%[1 - 15]的时间处于>90（清醒）。在3/15（20%）的参与者中检测到明显的脑电图抑制。在36/89（40%）的评估中，观察到的RASS与RASS目标相符。WAV的变异性以及脑电图抑制的发生率，突出了将RASS作为单一镇静测量方法的局限性，并表明辅助持续脑监测可能具有益处。
