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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2004

01-08-2004 | Original

Consciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium

Authors: E. Wesley Ely, Brenda Truman, Donna J. Manzi, Jeffrey C. Sigl, Ayumi Shintani, Gordon R. Bernard

Published in: Intensive Care Medicine | Issue 8/2004

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Abstract

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.
Literature
1.
De Jonghe B, Cook D, Appere-De-Vecchi C, Guyatt G, Meade M, Outin H (2000) Using and understanding sedation scoring systems: a systematic review. Intensive Care Med 26:275–285
2.
Ostermann ME, Keenan SP, Seiferling RA, Sibbald W (2000) Sedation in the intensive care unit. JAMA 283:1451–1459
3.
Jacobi J, Fraser GL, Coursin DB, Riker R, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke S, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA, Murray MJ, Peruzzi WT, Lumb PD (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141
4.
Weinert CR, Chlan L, Gross C (2001) Sedating critically ill patients: factors affecting nurses’ delivery of sedative therapy. Am J Crit Care 10:156–167
5.
Bair N, Bobek MB, Hoffman-Hogg L, Mion LC, Slomka J, Arroliga AC (2000) Introduction of sedative, analgesic, and neuromuscular blocking agent guidelines in a medical intensive care unit: physician and nurse adherence. Crit Care Med 28:707–713
6.
Ely EW, Stephens RK, Jackson JC, Thomason J, Truman B, Bernard G, Dittus R (2003) Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 Healthcare professionals. Crit Care Med 31:106–112
7.
Wit M de, Epstein SK (2003) Administration of sedatives and level of sedation: comparative evaluation via the sedation-agitation scale and the bispectral index. Am J Crit Care 12:343–348
8.
Mondello E, Siliotti R, Noto G, Cuzzocrea E, Scollo G, Trimarchi G, Venuti FS (2002) Bispectral index in ICU: correlations with Ramsay score on assessment of sedation level. J Clin Monit 17:271–277
9.
Berkenbosch JW, Fichter CR, Tobias JD (2001) The correlation of the bispectral index monitor with clinical sedation scores during mechanical ventilation in the pediatric intensive care unit. Anesth Analg 94:506–511
10.
Gilbert TT, Wagner MR, Halukurike V, Paz HL, Garland A (2001) Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients. Critical Care Med 29:1996–2000
11.
Frenzel D, Clemens-A G, Sommer C, Bauerle K, Roewer N (2002) Is the bispectral index appropriate for monitoring the sedation level of mechanically ventilated surgical ICU patients? Intensive Care Med 28:178–183
12.
Plum F, Posner J (1980) The diagnosis of stupor and coma. Davis, Philadelphia
13.
Romano J, Engel GL (1944) Delirium: electroencephalographic data. Arch Neurol Psychiatry 51:356–377
14.
Engel GL, Romano J (1944) Delirium: reversibility of the electroencephalogram with experimental procedures. Arch Neurol Psychiatry 51:378–392
15.
Jacobson SA, Leuchter AF, Walter DO (1993) Conventional and quantitative EEG in the diagnosis of delirium among the elderly. J Neurol Neurosurg Psychiatry 56:153–158
16.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
17.
Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Dittus R, Bernard G, Sessler CN (2003) Monitoring sedation status over time in ICU patients: the reliability and validity of the Richmond Agitation Sedation Scale (RASS). JAMA 289:2983–2991
18.
Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710
19.
Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW (2003) Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med 31:1226–1234
20.
Sessler CN, Gosnell M, Grap MJ, Brophy GT, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care patients. Am J Respir Crit Care Med 166:1338–1344
21.
Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard G, Inouye S (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29:1370–1379
22.
Nasraway SA, Wu EC, Kelleher RM, Yasuda CM, Donnelly AM (2002) How reliable is the Bispectral Index in critically ill patients? A prospective, comparative, single-blinded observer study. Crit Care Med 30:1483–1487
23.
Simmons LE, Riker R, Prato M, Fraser G (1999) Assessing sedation during intensive care unit mechanical ventilation with the bispectral index and the sedation-agitation scale. Crit Care Med 27:1499–1504
24.
Liang KY, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73:13–22
25.
De Deyne C, Struys M, Decruyenaere J, Creupelandt J, Hoste E, Colardyn F (1998) Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients. Intensive Care Med 24:1294–1298
26.
Riker RR, Fraser GL, Simmons LE, Wilkins ML (2001) Validating the sedation-agitation scale with the bispectral index and visual analog scale in adult ICU patients after cardiac surgery. Intensive Care Med 27:853–858
27.
McGaffigan P (2002) Advancing sedation assessment to promote patient comfort. Crit Care Nurse [Supp]:29–36
28.
Triltsch AE, Welte M, von Homeyer P, Grobe J, Genahr A, Moshirzadeh M, Sidiropoulos A, Konertz W, Kox WJ, Spies CD (2002) bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind placebo-controlled phase II study. Critical Care Med 30:1007–1014
29.
Billard V, Gambus PL, Chamoun N, Stanski DR, Shafer SL (1997) A comparison of spectral edge, delta power, and bispectral index as eeg measures of alfentanil, propofol, and midazolam drug effect. Clin Pharmacol Ther 61:45–58
30.
Kaplan L, Bailey H (2000) Bispectral index (BIS) monitorings of ICU patients on continual infusions of sedatives and paralytics reduces sedative drug utilization and cost. Crit Care 4:S110
31.
Campbell ML, Bizek KS, Stewart R (1998) Integrating technology with compassionate care: withdrawal of ventilation in a conscious patients with apnea. Am J Crit Care 7:85–89
32.
Vivien B, Paqueron X, Le Cosquer P, Langeron O, Coriat P, Riou B (2002) Detection of brain death onset using the bispectral index in severely comatose patients. Intensive Care Med 28:419–425
33.
Vivien B, Di Maria S, Ouatara A, Langeron O, Coriat P, Riou B (2003) Overestimation of bispectral index in sedated intensive care unit patients revealed by administration of muscle relaxant. Anesthesiology 99:9–17
34.
Riker R, Picard JT, Fraser G (1999) Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med 27:1325–1329
35.
Fraser GL, Riker RR (2001) Monitoring sedation, agitation, analgesia, and delirium in critically ill adult patients. Critical Care Clin 17:967–987
36.
McNicoll L, Pisani MA, Zhang Y, Ely EW, Siegel MD, Inouye SK (2003) Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 51:591–598
37.
Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK (2003) Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest 124:2267–2274
38.
Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066
39.
Stern PC, Carstensen LL (eds) (2000) The aging mind: opportunities in cognitive research, 1st edn. National Research Council
Metadata
Title
Consciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium
Authors
E. Wesley Ely
Brenda Truman
Donna J. Manzi
Jeffrey C. Sigl
Ayumi Shintani
Gordon R. Bernard
Publication date
01-08-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 8/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2298-1

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