An assessment of the validity of spectral entropy as a measure of sedation statein mechanically ventilated critically ill patients View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-02

AUTHORS

Timothy S. Walsh, Pamela Ramsay, T. Petteri Lapinlampi, Mika O. K. Särkelä, Hanna E. Viertiö-Oja, Pekka T. Meriläinen

ABSTRACT

OBJECTIVE: To assess whether the Entropy Module (GE Healthcare, Helsinki, Finland), a device to measure hypnosis in anesthesia, is a valid measure of sedation state in critically ill patients by comparing clinically assessed sedation state with Spectral Entropy DESIGN: Prospective observational study. SETTING: Teaching hospital general ICU. PATIENTS AND PARTICIPANTS: 30 intubated, mechanically ventilated patients without primary neurological diagnoses or drug overdose receiving continuous sedation. INTERVENTIONS: Monitoring of EEG and fEMG activity via forehead electrodes for up to 72h and assessments of conscious level using a modified Ramsay Sedation Scale. MEASUREMENTS AND RESULTS: 475 trained observer assessments were made and compared with concurrent Entropy numbers. Median State (SE) and Response (RE) Entropy values decreased as Ramsay score increased, but wide variation occurred, especially in Ramsay 4-6 categories. Discrimination between different sedation scores [mean (SEM) P(K) value: RE 0.713 (0.019); SE 0.710 (0.019)] and between lighter (Ramsay 1-3) vs.deeper (Ramsay 4-6) sedation ranges was inadequate [P(K): RE 0.750 (0.025); SE 0.748 (0.025)]. fEMG power decreased with increasing Ramsay score but was often significant even at Ramsay 4-6 states. Frequent "on-off" effects occurred for both RE and SE, which were associated with fEMG activity. Values switched from low to high values even in deeply sedated patients. High Entropy values during deeper sedation were strongly associated with simultaneous high relative fEMG powers. CONCLUSIONS: Entropy of the frontal EEG does not discriminate sedation state adequately for clinical use in ICU patients. Facial EMG is a major confounder in clinical sedation ranges. More... »

PAGES

308-315

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00134-007-0858-x

DOI

http://dx.doi.org/10.1007/s00134-007-0858-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1001189348

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/17898996


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43 schema:description OBJECTIVE: To assess whether the Entropy Module (GE Healthcare, Helsinki, Finland), a device to measure hypnosis in anesthesia, is a valid measure of sedation state in critically ill patients by comparing clinically assessed sedation state with Spectral Entropy DESIGN: Prospective observational study. SETTING: Teaching hospital general ICU. PATIENTS AND PARTICIPANTS: 30 intubated, mechanically ventilated patients without primary neurological diagnoses or drug overdose receiving continuous sedation. INTERVENTIONS: Monitoring of EEG and fEMG activity via forehead electrodes for up to 72h and assessments of conscious level using a modified Ramsay Sedation Scale. MEASUREMENTS AND RESULTS: 475 trained observer assessments were made and compared with concurrent Entropy numbers. Median State (SE) and Response (RE) Entropy values decreased as Ramsay score increased, but wide variation occurred, especially in Ramsay 4-6 categories. Discrimination between different sedation scores [mean (SEM) P(K) value: RE 0.713 (0.019); SE 0.710 (0.019)] and between lighter (Ramsay 1-3) vs.deeper (Ramsay 4-6) sedation ranges was inadequate [P(K): RE 0.750 (0.025); SE 0.748 (0.025)]. fEMG power decreased with increasing Ramsay score but was often significant even at Ramsay 4-6 states. Frequent "on-off" effects occurred for both RE and SE, which were associated with fEMG activity. Values switched from low to high values even in deeply sedated patients. High Entropy values during deeper sedation were strongly associated with simultaneous high relative fEMG powers. CONCLUSIONS: Entropy of the frontal EEG does not discriminate sedation state adequately for clinical use in ICU patients. Facial EMG is a major confounder in clinical sedation ranges.
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