脑电双频指数能可靠地监测机械通气患者的深度镇静:前瞻性多中心效度研究
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Bispectral Index Can Reliably Detect Deep Sedation in Mechanically Ventilated Patients: A Prospective Multicenter Validation Study
背景与目的
过度镇静在机械通气患者中普遍存在，但其对患者并无益处。我们假设脑电双频指数（BIS，一种量化监测脑电的方法）能准确测定镇静水平。
方 法
前瞻性纳入90名接受镇静的机械通气危重患者。BIS监测24小时，并每4小时与Richmond躁动镇静评分（RASS）比较。深度镇静定义为RASS -3～-5 。通过一预测数据集（45例患者，262次RASS评估）确定监测深度镇静的BIS基线阈值（RASS评估之前的最低值）和刺激BIS（标准化评估的最高值）。通过已经验证的数据集（45例患者，264次RASS评估）分析监测诊断的准确性。
结 果
仅6（6.7%）例患者提示存在深度镇静，但76例（84.4%）患者至少存在1小段深度镇静。50作为深度镇静基线，80作为刺激BIS， ROC曲线下面积分别为0.771（95%CI，0.714-0.828）和0.805（0.752-0.857）。基线BIS的敏感性和特异性分别为94%和66.5%，刺激BIS分别为91%和66.5%。当基线BIS和刺激BIS相结合时，敏感性、特异性和临床实用指数分别为85%（76.1% - 91.1%）、85.9%（79.5% - 90.7%）和66.9%（57.8% - 76%）。
结 论
联合基线BIS和刺激BIS可有助于监测机械通气患者的深度镇静。
原始文献摘要
Wang ZH, Chen H, Yang YL,et al.Bispectral Index Can Reliably Detect Deep Sedation in Mechanically Ventilated Patients: A Prospective Multicenter Validation Study[J]. Anesth Analg，2017 ,125(1):176-183. doi: 10.1213/ANE.0000000000001786.
BACKGROUND:
Excessively deep sedation is prevalent in mechanically ventilated patients and often considered suboptimal. We hypothesized that the bispectral index (BIS), a quantified electroencephalogram instrument, would accurately detect deep levels of sedation.
METHODS:
We prospectively enrolled 90 critically ill mechanically ventilated patients who were receiving sedation. The BIS was monitored for 24 hours and compared with the Richmond Agitation Sedation Scale (RASS) evaluated every 4 hours. Deep sedation was defined as a RASS of -3 to -5. Threshold values of baseline BIS (the lowest value before RASS assessment) and stimulated BIS (the highest value after standardized assessment) for detecting deep sedation were determined in a training set (45 patients, 262 RASS assessments). Diagnostic accuracy was then analyzed in a validation set (45 patients, 264 RASS assessments).
RESULTS:
Deep sedation was only prescribed in 6 (6.7%) patients, but 76 patients (84.4%) had at least 1 episode of deep sedation. Thresholds for detecting deep sedation of 50 for baseline and 80 for stimulated BIS were identified, with respective areas under the receiver-operating characteristic curve of 0.771 (95% confidence interval, 0.714-0.828) and 0.805 (0.752-0.857). The sensitivity and specificity of baseline BIS were 94.0% and 66.5% and of stimulated BIS were 91.0% and 66.5%. When baseline and stimulated BIS were combined, the sensitivity, specificity, and clinical utility index were 85.0% (76.1%-91.1%), 85.9% (79.5%-90.7%), and 66.9% (57.8%-76.0%), respectively.
CONCLUSIONS:
Combining baseline and stimulated BIS may help detect deep sedation in mechanically ventilated patients.
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