PURPOSE: Maintaining an optimal level of comfort and safety for critically ill patients is an universal goal for critical practitioners. The assessment of sedation level remains a challenge for the intensivist in order to avoid over- or under-sedation phenomena. The indroduction of the bispectral index (an EEG parameter) could bring potential adventages in monitoring sedation. The Richmond Agitation-Sedation Scale (RASS) has been shown to be highly reliable among multiple types of healt care professionals. The RASS has an expanded set of scores at pivotal levels of sedation that are determinated by patients' response to verbal vs physical stimulation, which will help the clinician in titrating medication.
METHODS: This is a prospective, nonramdomized, observational study in a surgical and trauma tertiary intensive care of an universitary hospital. Twenty-six consecutive postoperative thoracic patients (age range 17-68 yrs, mean age 44 yrs) were included. They were sedated (with propofol by continuos infusion at an initial dose of 2 mg/kg/h, which could be modulated with steps of 0′5 mg/kg/h), in order to mantein an adecuated RASS score. BIS value was continuosly recorded, and manually calculated on a mean average of a minute during the measuring of RASS score, and every 10 minutes for 6 hours on par with RASS score. ECG, SpO2, invasive arterial pressure, ventilatory module, ETCO2, FiO2, temperature were also recorded. For the statistic analysis, Friedman test and Spearman coefficient were utilized.
RESULTS: Nine hundred and thirty-six observations were carried out. The variation range of RASS score was between 0 and -5. BIS range varied from 27 to 96. Statistics analysis of the data obtained pointed out a significative correlation between RASS score and BIS (p < 0,01).
CONCLUSION: Acording to the reports, Bispectral index correlates with levels of sedation on the sedation scales. In our personal experience, this study demonstrates the utility of BIS and RASS score to track levels of sedation in postoperative thoracic surgery patients.
CLINICAL IMPLICATIONS: Bispectral index correlates with levels of sedation on the sedation scales.
DISCLOSURE: Rafael Badenes, None.