基于处理后脑电图的监测指导危重症成年患者镇静：国际专家小组基于共识的建议。
Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients: Recommendations from an International Expert Panel-Based Consensus.
机构信息
Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy.
Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
出版信息
Neurocrit Care. 2023 Apr;38(2):296-311. doi: 10.1007/s12028-022-01565-5. Epub 2022 Jul 27.
BACKGROUND
The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear.
METHODS
A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus.
RESULTS
According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues.
CONCLUSIONS
Evidence on using DOS monitors in ICU is still scarce, and further research is required to better define the benefits of using pEEG. This consensus highlights that some critically ill patients may benefit from this type of neuromonitoring.
背景
在麻醉中，使用处理后的脑电图（pEEG）进行镇静深度（DOS）监测的情况越来越多；然而，在重症监护病房（ICU）内，如何将这种监测类型用于成年危重症患者尚不清楚。
方法
一个由 21 名临床医生组成的国际多学科专家小组，根据他们在神经危重病学和神经麻醉学方面的专业知识，经过精心挑选，参与 ICU 患者 DOS 监测。小组成员被分配了四个领域（脑电图（EEG）监测技术、患者选择、使用 EEG 监测器、能力和培训 pEEG 监测原则），从中创建了一个问题和陈述清单，以解决这些问题。采用基于迭代方法的 Delphi 方法来生成最终陈述。陈述被归类为高度适当或高度不适当（中位数评分≥8）、适当（中位数评分≥7 但<8）或不确定（中位数评分<7），以及具有强烈分歧指数（DI）（DI<0.5）或弱 DI（DI≥0.5 但<1）共识。
结果
根据专家组评估的陈述，额部 pEEG（包括连续彩色密度频谱图）被认为足以监测镇静水平（强烈共识），并且专家组建议所有接受镇静（麻痹或非麻痹）且不适合临床评估的患者（强烈共识）在 ICU 工作人员完成特定的培训计划后，将从 DOS 监测中受益。为了弥补知识/理性和常规应用之间的差距，必须打破一些障碍，包括缺乏知识、对延长镇静的验证、基于不同 EEG 分析算法的监视器之间的标准化以及经济问题。
结论
关于在 ICU 中使用 DOS 监测器的证据仍然很少，需要进一步研究以更好地定义使用 pEEG 的益处。这一共识强调，某些危重症患者可能受益于这种类型的神经监测。
Zotero 插件