Consciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium
Consciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium
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DOI：
10.1007/s00134-004-2298-1
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发表时间：
2004-08-01
影响因子：
38.9
通讯作者：
Bernard, GR
中科院分区：
文献类型：
--
作者：
Ely, EW;Truman, B;Bernard, GR
Objective.脑电双频指数（BIS）正在被评估为意识的监测器，但目前还不清楚意识的哪些组成部分（即，唤醒与意识内容）BIS测量。这项研究比较了BIS水平和经过充分验证的唤醒和谵妄存在或不存在的临床指标。设计一项前瞻性、设盲、观察性队列研究。患者124例机械通气的成人内科ICU患者。测量和结果。使用BIS 3.4和BIS-XP 4.0算法，在临床评估前即刻计算BIS值。临床评估包括里士满躁动-镇静量表（RASS）和是否存在谵妄（使用ICU的意识模糊评估方法）。共收集了124名患者的484项评估。BIS-XP值与RASS的相关性大于BIS 3.4（R-2=0.36 vs. 0.20），尽管在RASS水平上BIS-XP评分仍有相当大的重叠。谵妄和非谵妄观察结果的中位BIS-XP值分别为74和96，而BIS 3.4值分别为91和96。然而，在控制RASS值后，BIS 3.4和BIS-XP均与谵妄无显著相关性。结论.与机械通气患者觉醒的临床测量相比，BIS-XP算法与RASS水平的相关性比BIS 3.4更强，但使用两种算法时，不同觉醒水平之间存在明显重叠。在控制觉醒水平后，BIS-XP和BIS 3.4算法都不能区分谵妄的存在和不存在。
Objective. Bispectral index (BIS) is being evaluated as a monitor of consciousness, yet it is unclear what components of consciousness (i.e., arousal vs. content of consciousness) the BIS measures. This study compared BIS levels to well-validated clinical measures of arousal and the presence or absence of delirium. Design. A prospective, blinded, observational cohort study. Patients. 124 mechanically ventilated, adult, medical ICU patients. Measurements and results. Using BIS 3.4 and BIS-XP 4.0 algorithms, BIS values were calculated immediately prior to clinical assessments. The clinical assessments included the Richmond Agitation-Sedation Scale (RASS) and presence or absence of delirium using the Confusion Assessment Method for the ICU. A total of 484 assessments were collected among 124 patients. BIS-XP values demonstrated greater correlation with RASS than BIS 3.4 (R-2=0.36 vs. 0.20), although considerable overlap of BIS-XP scores remained across RASS levels. Median BIS-XP values for delirious and nondelirious observations were 74 and 96, respectively, while BIS 3.4 values were 91 and 96, respectively. However, neither BIS 3.4 nor BIS-XP were significantly associated with delirium after controlling for RASS value. Conclusions. In comparison with clinical measures of arousal in mechanically ventilated patients, BIS-XP algorithm demonstrated stronger correlation with RASS levels than did BIS 3.4, yet marked overlap across different levels of arousal persist using both algorithms. After controlling for level of arousal, neither BIS-XP nor BIS 3.4 algorithms distinguished between the presence and absence of delirium.