Use of Bispectral Index Monitoring to Detect Early Deep Sedation in Mechanically Ventilated Patients
CCCF ePoster library. Xu M. Oct 27, 2015; 117295; P62 Disclosure(s): The study was supported by a grant from the Beijing Municipal Health Bureau (2014-2-2041).
Dr. Ming Xu
Dr. Ming Xu
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Topic: Retrospective or Prospective Cohort Study

Use of Bispectral Index Monitoring to Detect Early Deep Sedation in Mechanically Ventilated Patients

Ming Xu, Z. Wang, H. Chen, M. Xu

Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China | Department of Critical Care Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China | Surgical Intensive Care Unit, Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, China | Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Introduction: Early deep sedation is prevalent and associated with adverse outcomes in mechanically ventilated patients. Subjective scale instruments for sedation evaluation are inadequate for timely detection of deep sedation.

Objectives: Our primary aim was to clarify the diagnostic accuracy of BIS in detecting early deep sedation against the reference standard subjective scale instrument (RASS). We hypothesized that low BIS level at baseline could predict deep sedation and inadequate BIS response after external stimulation could help to confirm deep sedation.

Methods: We prospectively enrolled adult patients within 24 hours of initiating mechanical ventilation. Bispectral Index was monitored for 24 hours, and the Richmond Agitation Sedation Scale was evaluated every 4 hours. Deep sedation was defined as a Sedation Scale of -3 to -5. We collected Bispectral Index values within 15 minutes before and after the Sedation Scale assessment. Baseline and responsive Bispectral Index were defined as the minimum value before and the maximum value after the Sedation Scale assessment, respectively.

Results: We studied 45 patients and completed 262 Sedation Scale assessments (figure 1). Deep sedation occurred in 113 (43.1%) of the assessments. The areas under the receiver operating characteristic curves (95% confidence interval) of baseline and responsive Bispectral Index were 0.771 (0.714-0.828) and 0.805 (0.752-0.857), respectively (figure 2 and 3). The respective optimum cut points of the baseline and responsive Bispectral Index were 47 and 73. The sensitivity and specificity (95% confidence interval) of the baseline Bispectral Index were 83.2% (74.7%-89.3%) and 62.4% (54.1%-70.1%), respectively. The respective sensitivity and specificity of the responsive Bispectral Index were 62.8% (53.2%-71.6%) and 83.9 (76.8%-89.2%).

Conclusion: Bispectral Index monitoring can be used as an adjunct tool in screening and confirming deep sedation during the early period of mechanical ventilation.

References: 1. Shehabi Y, Bellomo R, ReadeMC, Bailey M, Bass F, Howe B, McArthur C, Seppelt IM, Webb S, Weisbrodt L;Sedation Practice in Intensive Care Evaluation (SPICE) Study Investigators;ANZICS Clinical Trials Group. Early intensive care sedation predicts long-termmortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012;186:724-731.
2.Tanaka LM, Azevedo LC, Park M, Schettino G, Nassar AP, Rea-Neto A, Tannous L, de Souza-Dantas VC, Torelly A, Lisboa T, Piras C, Carbalho FB, Maia Mde O, Giannini FP, Machado FR, Dal-Pizzol F, de Carvalho AG, dos Santos RB, Tierno PF, Soares M, Salluh JI; ERICC study investigators. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care 2014;18:R156.
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