系统评价和 bispectral index（BIS）与临床镇静评分相关性的荟萃分析：旨在确定 BIS 在危重症患者中的作用。
Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients.
机构信息
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland, USA.
出版信息
Pharmacotherapy. 2022 Aug;42(8):667-676. doi: 10.1002/phar.2712. Epub 2022 Jun 30.
INTRODUCTION
The bispectral index (BIS) is an attractive approach for monitoring level of consciousness in critically ill patients, particularly during paralysis, when commonly used sedation scales cannot be used.
OBJECTIVES
As a first step toward establishing the utility of BIS during paralysis, this review examines the strength of correlation between BIS and clinical sedation scales in a broad population of non-paralyzed, critically ill adults.
METHODS
We included studies evaluating the strength of correlation between concurrent assessments of BIS and Richmond Agitation Sedation Scale (RASS), Ramsay Sedation Scale (RSS), or Sedation Agitation Scale (SAS) in critically ill adult patients. Studies involving assessment of depth sedation periperative or procedural time periods, and those reporting BIS and sedation scale assessments conducted >5 min apart or while neuromuscular blocking agents (NMBA) were administered, were excluded. Data were abstracted on sedation scale, correlation coefficients, setting, patient characteristics, and BIS assessment characteristics that could impact the quality of the studies.
RESULTS
Twenty-four studies which enrolled 1235 patients met inclusion criteria. The correlation between BIS and RASS, RSS, and SAS overall was 0.68 (95% confidence interval, 0.61-0.74, Ƭ = 0.06 I = 71.26%). Subgroup analysis by sedation scale indicated that the correlation between BIS and RASS, RSS, and SAS were 0.66 (95% confidence interval 0.58-0.73, Ƭ = 0.01 I = 30.20%), 0.76 (95% confidence interval 0.69-0.82, Ƭ = 0.04 I = 67.15%), and 0.53 (95% confidence interval 0.42-0.63, Ƭ = 0.01 I = 26.59%), respectively. Factors associated with significant heterogeneity included comparator clinical sedation scale, neurologic injury, and the type of intensive care unit (ICU) population.
CONCLUSIONS
BIS demonstrated moderate to strong correlation with clinical sedation scales in adult ICU patients, providing preliminary evidence for the validity of BIS as a measure of sedation intensity when clinical scales cannot be used. Future studies should determine whether BIS monitoring is safe and effective in improving outcomes in patients receiving NMBA treatment.
简介
双频谱指数（BIS）是监测危重病患者意识水平的一种很有吸引力的方法，特别是在使用麻痹药物时，通常使用的镇静评分无法使用。
目的
作为在麻痹状态下建立 BIS 实用性的第一步，本综述检查了 BIS 与广泛的非麻痹危重病成人患者的临床镇静评分之间的相关性强度。
方法
我们纳入了评估 BIS 与 Richmond 躁动镇静评分（RASS）、Ramsay 镇静评分（RSS）或镇静躁动评分（SAS）同时评估的相关性的研究。研究涉及评估围手术期或手术期间的深度镇静，以及报告 BIS 和镇静评分评估之间的间隔超过 5 分钟或在使用神经肌肉阻滞剂（NMBA）时进行的研究被排除在外。数据摘要包括镇静评分、相关系数、设置、患者特征以及可能影响研究质量的 BIS 评估特征。
结果
共有 24 项研究纳入了 1235 名患者，符合纳入标准。BIS 与 RASS、RSS 和 SAS 的总体相关性为 0.68（95%置信区间，0.61-0.74，Ƭ=0.06 I=71.26%）。按镇静评分进行的亚组分析表明，BIS 与 RASS、RSS 和 SAS 的相关性分别为 0.66（95%置信区间 0.58-0.73，Ƭ=0.01 I=30.20%）、0.76（95%置信区间 0.69-0.82，Ƭ=0.04 I=67.15%）和 0.53（95%置信区间 0.42-0.63，Ƭ=0.01 I=26.59%）。与显著异质性相关的因素包括比较的临床镇静评分、神经损伤和重症监护病房（ICU）人群的类型。
结论
BIS 与成人 ICU 患者的临床镇静评分呈中度至高度相关，为临床评分无法使用时 BIS 作为镇静强度测量的有效性提供了初步证据。未来的研究应确定在接受 NMBA 治疗的患者中使用 BIS 监测是否安全有效。
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