Frequency and clinical impact of preserved bispectral index activity during deep sedation in mechanically ventilated ICU patients View Full Text


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Article Info

DATE

2009-09-15

AUTHORS

Pierre Trouiller, Pascal Fangio, Catherine Paugam-Burtz, Corinne Appéré-de-Vecchi, Paul Merckx, Nicolas Louvet, Sebastian Pease, Hervé Outin, Jean Mantz, Bernard De Jonghe

ABSTRACT

ObjectiveDespite an overall correlation between the bispectral index of the EEG (BIS) and clinical sedation assessment, unexpectedly high BIS values can be observed at deep sedation levels. We assessed the frequency, interindividual variability and clinical impact of high BIS values during clinically deep sedation.Design and settingProspective observational study in two university-affiliated intensive care units.PatientsSixty-two mechanically ventilated patients requiring intravenous sedation and analgesia for ≥24 h.Measurements and main resultsPaired measurements of BIS and sedation measured on the adaptation to intensive care environment (ATICE) score were obtained every 3 h until awakening. A paired measurement with BIS >60 at deep sedation (ATICE Awakeness ≤2) was defined as discordant. Patients were considered discordant if their individual ratio of number of discordant measurements to number of total measurements during deep sedation was above the median discordance ratio of the overall cohort. At least one discordant assessment was observed in 52 patients (83.9%). Median individual discordance ratio was 32% (14.3–50.0%). Time from awakening to first T-piece trial [16 h (4–34) vs. 46 h (9–109), p = 0.01] and to extubation [35 h (23–89) vs. 88 h (46–152 h), p = 0.05] were significantly shorter in discordant compared to concordant patients. BIS-ATICE discordance was independently associated with successful extubation within 48 h after awakening (OR 6.7, CI 95% 1.8–25.0, p = 0.005). The rate of ICU recall was not different in BIS-ATICE discordant and concordant patients.ConclusionsIn mechanically ventilated ICU patients, discordance between high BIS values and deep clinical sedation is frequently observed and may suggest faster weaning from the ventilator. More... »

PAGES

2096

References to SciGraph publications

  • 2002-07. Bispectral Index In ICU: Correlation With Ramsay Score On Assessment Of Sedation Level in JOURNAL OF CLINICAL MONITORING AND COMPUTING
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  • 2001-07-17. Delirium in an intensive care unit: a study of risk factors in INTENSIVE CARE MEDICINE
  • 2002-01-12. Is the bispectral index appropriate for monitoring the sedation level of mechanically ventilated surgical ICU patients? in INTENSIVE CARE MEDICINE
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  • 2004-02-06. Does ICU-acquired paresis lengthen weaning from mechanical ventilation? in INTENSIVE CARE MEDICINE
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00134-009-1636-8

    DOI

    http://dx.doi.org/10.1007/s00134-009-1636-8

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1008190958

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19756502


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    33 schema:description ObjectiveDespite an overall correlation between the bispectral index of the EEG (BIS) and clinical sedation assessment, unexpectedly high BIS values can be observed at deep sedation levels. We assessed the frequency, interindividual variability and clinical impact of high BIS values during clinically deep sedation.Design and settingProspective observational study in two university-affiliated intensive care units.PatientsSixty-two mechanically ventilated patients requiring intravenous sedation and analgesia for ≥24 h.Measurements and main resultsPaired measurements of BIS and sedation measured on the adaptation to intensive care environment (ATICE) score were obtained every 3 h until awakening. A paired measurement with BIS >60 at deep sedation (ATICE Awakeness ≤2) was defined as discordant. Patients were considered discordant if their individual ratio of number of discordant measurements to number of total measurements during deep sedation was above the median discordance ratio of the overall cohort. At least one discordant assessment was observed in 52 patients (83.9%). Median individual discordance ratio was 32% (14.3–50.0%). Time from awakening to first T-piece trial [16 h (4–34) vs. 46 h (9–109), p = 0.01] and to extubation [35 h (23–89) vs. 88 h (46–152 h), p = 0.05] were significantly shorter in discordant compared to concordant patients. BIS-ATICE discordance was independently associated with successful extubation within 48 h after awakening (OR 6.7, CI 95% 1.8–25.0, p = 0.005). The rate of ICU recall was not different in BIS-ATICE discordant and concordant patients.ConclusionsIn mechanically ventilated ICU patients, discordance between high BIS values and deep clinical sedation is frequently observed and may suggest faster weaning from the ventilator.
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