Tobar Eduardo, Farías José I, Rojas Verónica, Penna Antonello, Egaña José I, Ponce Daniela, Bravo Daniela, Maldonado Felipe, Gajardo Abraham, Gutiérrez Rodrigo
Critical Care Unit, Department of Medicine, Hospital Clínico de la Universidad de Chile, Santiago, Chile.
Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico de la Universidad de Chile, Santiago, Chile.
Front Med (Lausanne). 2022 Nov 4;9:1013430. doi: 10.3389/fmed.2022.1013430. eCollection 2022.
Sedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD).
We conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control ( = 25) or multiparameter group ( = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD).
There was no difference in VFD at day 30 (median: 11 [IQR 0-20] days in the control group vs. 0 [IQR 0-21] days in the BIS multiparameter group, = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9-2.8) mg/k/h in the control group vs. 1.9(IQR 1.5-2.2) mg/k/h in the MP group, = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period.
A sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration.
2019冠状病毒病（COVID-19）患者的镇静已被视为一项重大挑战。我们旨在研究使用多参数脑电图（EEG）方案指导COVID-19患者的镇静是否会增加30天无机械通气天数（VFD）。
我们进行了一项双盲随机临床试验。纳入因COVID-19导致严重肺炎且需要机械通气（MV）和深度镇静的患者。我们将患者随机分为对照组（n = 25）或多参数组（n = 25）。干预组的镇静按照标准机构方案进行，并根据一个流程图进行，该流程图旨在当脑电图抑制率超过2%或频谱边缘频率95（SEF95）低于10 Hz时降低丙泊酚给药剂量。我们进行了意向性分析以评估我们的主要结局（30天VFD）。
第30天的VFD无差异（中位数：对照组为11天[四分位间距0 - 20天]，BIS多参数组为0天[四分位间距0 - 21天]，P = 0.87）。在次要结局中，我们记录到在方案实施的前5天内，调整后的丙泊酚总给药量减少了17%[中位数：对照组为2.3（四分位间距1.9 - 2.8）mg/kg/h，多参数组为1.9（四分位间距1.5 - 2.2）mg/kg/h，P = 0.005]。这伴随着干预组在整个治疗期间的平均脑电双频指数（BIS）值更高。
由多变量脑电图衍生参数指导的镇静方案并未增加30天VFD。然而，该干预导致丙泊酚总给药量减少。
